A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative Staphylococcus aureus (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.

A 69-year-old woman underwent aortic valve replacement (AVR) for prosthetic valve (Freestyle^TM stentless valve) endocarditis (PVE) in April 2001. The patient was admitted to our hospital with diarrhea and tarry stools in January 2002 and was treated with intravenous hyperalimentation. She had fever and inflammatory findings at 1 week after admission, and was given intravenous antibiotics. Symptoms and laboratory findings improved gradually, but transesophageal echocardiography revealed a mobile mass in the ascending aorta near the noncoronary sinus of Valsalva. The serum β_-D glucan level was elevated and blood culture was positive for Candida parapsilosis. These findings suggested fungal endocarditis of the ascending aorta, so the patient underwent surgery. Vegetation was attached to the aortic wall near the noncoronary sinus of Valsalva. It was removed with part of the ascending aorta, followed by reconstruction with a gusset xenograft. In addition, aortic valve replacement was performed with a mechanical valve. The resected tissue grew C. parapsilosis, so parenteral anti-fungal drugs were administered intravenously for 8 weeks after surgery. Although cerebral infarction occurred, she was discharged on the 133rd postoperative day. There was no recurrence of infection and she remained on oral anti-fungal medication for 24 months postoperatively.