Two Cases of Bioprosthetic Valve Stenosis of the Aortic Valve Position Found on Weaning of a Nipro Left Ventricular Assist Device

Takashi Shuto＊	Hirofumi Anai＊	Tomoyuki Wada＊
Hideyuki Tanaka＊	Madoka Kawano＊	Takayuki Kawashima＊
Tadashi Umeno＊	Kenji Yoshimura＊	Kaoru Uchida＊
Shinji Miyamoto＊

（Department of Cardiovascular Surgery, Faculty of Medicine, Oita University＊, Yufu, Japan）

The first case was a 67-year-old woman. She had been given a diagnosis of fulminant myocarditis and received a biventricular assist device as a bridge to recovery. A Nipro ventricular assist device（VAD）was implanted into her left heart. She was also found to have moderate aortic insufficiency before the operation, so she received aortic valve replacement（AVR）with a bioprosthetic valve（CEP Magna Ease 21mm）at the same time. Her cardiac function recovered gradually. Therefore, a weaning operation was scheduled for three months after the VAD implantation. However, her left ventricle motion was very poor when she was taken off of the extracorporeal circulation after removing the VAD, and transesophageal echocardiography（TEE）revealed severe bioprosthetic valve stenosis. When her heart was stopped again and the bioprosthetic valve was observed, the leaflets of the bioprosthetic valve were fused. Commissural fusion of bioprosthetic valve was able to be released using forceps, and the punnus extending under the leaflet was removed. In this way, the function of the bioprosthetic valve was restored. Her cardiac motion became good, and removal from extracorporeal circulation was easily achieved. She left the hospital 100 days after weaning from the VAD. The second case was a 68-year-old woman. She also had fulminant myocarditis. She underwent biventricular assist device implantation and AVR（CEP Magna Ease 19 mm). Her cardiac function recovered, and a weaning operation was scheduled on the 73rd-postoperative day. Preoperative TEE before the weaning of VAD showed severe bioprosthetic valve stenosis. The commissural fusion of the bioprosthetic valve was released and the punnus extending under the leaflet removed at the same time as the VAD was removed. Re-valve replacement was not required. We should therefore consider the possibility of bioprosthetic valve stenosis when VAD implantation and AVR with a bioprosthetic valve are performed at the same time in patients with an extremely reduced cardiac function.

 

Jpn. J. Cardiovasc. Surg. 47:58-61（2018）

Keywords：fulminant myocarditis;Nipro LVAD;aortic valve replacement;bioprosthetic valve stenosis