26675562 Visualization

Our patient was a 50 Age - year Age old Age man Sex with bicuspid Detailed_description aortic Sign_symptom valve Sign_symptom insufficiency Sign_symptom and ascending Detailed_description aorta Sign_symptom dilatation Sign_symptom .
He had undergone a free Detailed_description - hand Detailed_description aortic Biological_structure homograft Therapeutic_procedure implantation Therapeutic_procedure with replacement Therapeutic_procedure of the non Biological_structure - coronary Biological_structure sinus Biological_structure using a 24 Detailed_description - mm Detailed_description homograft Detailed_description in 2006 Date (at the age of 41).
Follow Clinical_event - up Clinical_event evaluations were performed every Frequency 6 Frequency months Frequency and showed mild Severity aortic Sign_symptom valve Sign_symptom insufficiency Sign_symptom .
After 8 Duration years Duration of follow Clinical_event - up Clinical_event , the patient presented Clinical_event to hospital Nonbiological_location with fever Sign_symptom and the echocardiography Diagnostic_procedure showed severe Severity aortic Sign_symptom insufficiency Sign_symptom due to a rupture Sign_symptom of one Biological_structure of Biological_structure the Biological_structure cusps Biological_structure of Biological_structure the Biological_structure homograft Biological_structure , worsening Lab_value of cardiac Diagnostic_procedure contractility Diagnostic_procedure with left Diagnostic_procedure ventricular Diagnostic_procedure ejection Diagnostic_procedure fraction Diagnostic_procedure ( LVEF Diagnostic_procedure ) depression Lab_value (40–45%) and dilatation Sign_symptom of Sign_symptom the Sign_symptom left Sign_symptom ventricle Sign_symptom ( telediastolic/telesystolic Lab_value diameters Lab_value 60/42 Lab_value mm Lab_value , respectively).
The patient presented orthopnoea Sign_symptom and hypotension Sign_symptom , which needed infusion Administration of dopamine Medication and diuretics Medication .
Computed Diagnostic_procedure tomography Diagnostic_procedure scan showed calcifications Sign_symptom on the homograft Biological_structure , pleural Sign_symptom effusions Sign_symptom and no signs of pericardial Sign_symptom effusion Sign_symptom (Fig.1).
Since the Dukes Diagnostic_procedure criteria Diagnostic_procedure for Diagnostic_procedure endocarditis Diagnostic_procedure were not Lab_value satisfied Lab_value , the final diagnosis was an early structural Disease_disorder deterioration Disease_disorder of the homograft Biological_structure , due to a severe Severity calcification Sign_symptom process.
The operation Therapeutic_procedure was performed through median Detailed_description resternotomy Therapeutic_procedure and with standard Detailed_description aorta Biological_structure - right Biological_structure atrium Biological_structure central Therapeutic_procedure cannulation Therapeutic_procedure for the extracorporeal circulation.
The leaflets Biological_structure and the annulus Biological_structure of the homograft Biological_structure presented severe Severity calcifications Sign_symptom and no signs of endocarditis Disease_disorder were found.
An Edwards Detailed_description Intuity Detailed_description bioprosthesis Therapeutic_procedure (21 mm) was then implanted Therapeutic_procedure (Fig.2).
The cross Therapeutic_procedure - clamping Therapeutic_procedure time was 41 Duration min Duration , and the cardiopulmonary Therapeutic_procedure bypass Therapeutic_procedure time was 64 Duration min Duration .
The patient required dopamine Medication and adrenaline Medication at low Dosage doses Dosage for bypass weaning.
No complications Sign_symptom occurred during the postoperative Therapeutic_procedure period Therapeutic_procedure .
Echocardiography Diagnostic_procedure before the discharge Clinical_event showed the absence of paravalvular Sign_symptom leaks Sign_symptom , a peak/mean Diagnostic_procedure aortic Diagnostic_procedure gradient Diagnostic_procedure of 34/20 Lab_value mmHg Lab_value and an LVEF Diagnostic_procedure of 33% Lab_value .
Follow-up echocardiography Diagnostic_procedure after Date 3 Date months Date from the operation showed neither leaks Sign_symptom nor malfunctions Sign_symptom of the Edwards Detailed_description Intuity Detailed_description prosthesis Biological_structure , a peak/mean Diagnostic_procedure gradient Diagnostic_procedure of 38/22 Lab_value mmHg Lab_value and initial Lab_value recovery Lab_value of the LVEF Diagnostic_procedure (valued 47% Lab_value ).
Patient was asymptomatic Sign_symptom again.