The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation

Adult ; Angina Pectoris ; etiology ; Aortic Valve Insufficiency ; complications ; Bradycardia ; etiology ; Female ; Heart Valve Prosthesis ; Humans ; Prosthesis Failure

Aged ; Aortic Aneurysm ; diagnostic imaging ; etiology ; Aortic Valve Insufficiency ; diagnostic imaging ; Echocardiography ; Giant Cell Arteritis ; complications ; diagnostic imaging ; Humans ; Male

OBJECTIVETo summarize operational effect with surgical treatment of aortic regurgitation caused by Behcet's disease and discuss relevant surgical techniques for treatment of these conditions.

METHODSEight patients with aortic regurgitation secondary to Behcet's disease and received surgery between April 1997 and August 2003 were retrospetively analyzed. Among them, two patients had their aortic valves replaced in other hospital before admitted to our hospital where one undertook aortic valve replacement (AVR), and the other undertook aortic root replacement (ARR). In six patients who were initially treated in our hospital, the surgical procedures for aortic regurgitation included AVR in three patients and ARR operation in other three patients in whom Bentall-type operation was conducted in two patients and Cabrol-type operation in one.

RESULTSOne patient died during hospital stay. The follow-up periods ranged from 3 months to 36 months. In five patients with prosthetic valve detachment or suture detachment, redo homograft replacement was required in one patient and redo AVR in 3, one patient had redo AVR twice, and the remaining one patient had no surgery at present. Three patients primarily operated by ARR operation have no complications.

CONCLUSIONSThe rate of prosthetic valve detachment is high in patients with Behcet's disease. ARR should be a first-line therapy for operation promised these patients.

Adult ; Aortic Valve Insufficiency ; etiology ; surgery ; Behcet Syndrome ; complications ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Retrospective Studies

Acute Coronary Syndrome ; etiology ; Aortic Valve Insufficiency ; Female ; Heart Valve Prosthesis ; adverse effects ; Humans ; Middle Aged ; Prosthesis Failure

Adult onset Still's disease (AOSD) is an uncommon acute systemic inflammatory disease of unknown origin. The clinical features include high spiking fever, arthralgia or arthritis, transient maculopapular rash, lymphadenopathy, hepatosplenomegaly, and serositis. Pericarditis is the most common cardiac manifestation of AOSD and occurs in approximately 30% of cases. A simultaneous occurrence of rapidly progressive bi-valvular regurgitation associated with AOSD has not been previously described. We report a case of a 55-year old woman who underwent mitral valve replacement and Bentall's operation due to acute severe mitral and aortic regurgitation associated with AOSD.
Time Factors ; Still's Disease, Adult-Onset/*complications ; Mitral Valve Insufficiency/*etiology/pathology ; Middle Aged ; Humans ; Female ; Aortic Valve Insufficiency/*etiology/pathology ; Age Factors ; Acute Disease

OBJECTIVES: To assess the clinical features, pathologic findings, postoperative results and the effects of immunosuppressive therapy in patients with Beh et's disease (BD). METHODS: We reviewed the postoperative course of the 9 BD patients who underwent a total of 17 aortic valve replacement procedures with prosthetic valves. RESULTS: Histological examination of the aortic valve commonly revealed diffuse myxoid degeneration (75 percent). Of 17 valve replacement surgeries, 13 surgeries resulted in complications, such as detachment of the prosthetic valve with perivalvular leakage and dehiscence of the sternotomy wound, within an average of 5 months (range from 1 month to 14 months). The rate of prosthetic valve detachment was 76 percent (13 of 17 surgeries). Four of the 9 patients (44 percent) who underwent aortic valve replacement procedures died of heart failure or infection associated with the detachment of the prosthetic valve, and perivalvular leakage within an average of 9 months. Aortic insufficiency associated with dehiscence of the prosthetic valve developed in 11 of 12 surgical cases (92 percent) with a mechanical valve and 2 of 5 surgical cases (40 percent) with tissue valves. Thirteen of 15 surgeries (87 percent) which were not given postoperative immunosuppressive therapy developed complications, while none of 2 surgeries that used postoperative immunosuppressive therapy with prednisolone (1 mg/kg/day) and azathioprine (100 mg/day) had these complications. CONCLUSION: The rates of prosthetic valve detachment in BD involving aortic valve were higher than those of other diseases. Aortic valve involvement was also one of the poor prognostic factors in BD. Intensive postoperative immunosuppressive therapy and surgical methods may be important factors for postoperative results.
Adult ; Aortic Valve/pathology ; Aortic Valve Insufficiency/*etiology/pathology ; Behcet Syndrome/*complications/drug therapy/pathology ; Female ; Heart Valve Diseases/*complications/pathology/surgery ; Heart Valve Prosthesis Implantation/*mortality ; Human ; Immunosuppression ; Male ; Postoperative Complications ; Prosthesis Failure ; Survival Analysis

Acute Disease ; Aged ; Aortic Valve Insufficiency ; etiology ; Coronary Artery Disease ; complications ; Humans ; Male ; Percutaneous Coronary Intervention ; adverse effects

Outcome of adult patients with repaired tetralogy of Fallot (TOF) was studied with emphasis on postrepair problems. A retrospective review of clinical, echocardiographic, catheterization, and surgical data was performed for 48 patients who underwent corrective repair of TOF after 15 years of age. All patients survived total repair and have been followed up from 3 months to 11 years (median 4.6 years). Postoperatively, 81.3% of patients were in functional class I and 85.4% had normal right ventricular function. One patient (2.1%) died during follow-up. There were 6 reoperations (12.5%) in 5 patients. The indications for reoperation included residual ventricular septal defect (VSD) (n=1), right ventricular outflow obstruction with VSD (n=4), and pulmonary regurgitation (n=1). The 10-year actuarial survival rate was 97.1%, and the 10-year freedom from reoperation was 81.3%. Aortic regurgitation was seen preoperatively in 6 patients (12.5%) and there were 2 newly developed aortic regurgitations after operation, one of which was caused by infective endocarditis. Corrective repair of TOF can be recommended in this patient group since the survival rate, postrepair functional status and hemodynamics are acceptable. Continued close follow-up, however, is essential for early identification and correction of post-repair problems.
Adolescence ; Adult ; Aortic Valve Insufficiency/etiology ; Electrocardiography ; Female ; Follow-Up Studies ; Human ; Male ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Tetralogy of Fallot/surgery* ; Treatment Outcome

We herein report a rare case of subaortic stenosis in association with a previous tetralogy of Fallot (TOF) surgical repair, which was not taken into account as a differential diagnosis. Echocardiography plays a pivotal role in identification of this rare combination. Therefore, echocardiography should be performed periodically during follow-up of patients with surgically corrected TOF. Given the clinical complications that can result from subaortic stenosis (i.e., aortic regurgitation and infective endocarditis), early and aggressive management of this rare combination should be performed.
Adult ; Aortic Valve Insufficiency/etiology ; Discrete Subaortic Stenosis/*complications/surgery/ultrasonography ; Echocardiography ; Female ; Heart Defects, Congenital/*complications/surgery/ultrasonography ; Humans ; Tetralogy of Fallot/*complications/surgery/ultrasonography ; Time Factors