VALVE DETACHMENT AFTER AORTIC-VALVE REPLACEMENT - A SUCCESSFULLY REOPERATED CASE WITH THE CABROL TECHNIQUE

A 50-year-old Japanese male was admitted with a 1 month history of pro gressive shortness of breath, palpitations, and intermittent low-grade fever. On admission, a musical diastolic murmur (sea-gull murmur) was heard on the 3rd left sternal border. Blood studies showed an acceler ated erythrocyte sedimentation rate, and positive C-reactive protein. Retrograde aortography revealed severe aortic regurgitation. At the op eration, the aortic wall was remarkably thickened, and the aortic valv e commissures between the right and left coronary cusps and between th e left and non-coronary cusps had completely detached from the aortic wall. The aortic valve was replaced with a St Jude Medical valve using pledgeted sutures. Histologic studies of the aorta and aortic valve r evealed no evidence of any pathologic changes. Echocardiography perfor med 82 days after aortic valve replacement showed severe paravalvular leakage and valve detachment. At the reoperation, the prosthetic valve was detached from the extremely edematous and fragile native aortic a nnulus. There was no vegetation or abscess formation. Aortic root repl acement with the Cabrol technique was performed using a composite graf t in which the prosthetic valve was placed 1 cm above the proximal ext remity to reduce the tension on the suture line and the aortic annulus . Histologic study of the aorta after the reoperation showed non-speci fic inflammatory disease. The patient, who received steroid therapy, h as recovered without any signs of graft detachment or pseudoaneurysm f ormation.