Aortic valve replacement with autogenous aortic wall |
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| Affiliation: | 1. Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;2. Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;4. Heart Science and Medical Devices Research Center, National Cheng Kung University, Tainan, Taiwan;3. Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;5. Department of Electrical Engineering, Kao-Yuan University, Kaohsiung, Taiwan;6. First Faculty of Medicine, Charles University, Prague, Czech Republic;1. Mandel Center for Heart and Vascular Research, and the Duke Cardiovascular Research Center, Duke University Medical Center, Durham, NC 27710, USA;2. Department of Surgery, Duke University, Durham, NC 27710, USA;1. Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA;2. Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, USA;3. Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, Minnesota, USA;4. Department of Anesthesiology, TVHS VA Medical Center, Nashville, Tennessee, USA;5. Departments of Anesthesiology and Pharmacology, Vanderbilt University, Nashville, Tennessee, USA |
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| Abstract: | A new operation for replacement of the severely diseased aortic valve is described. The replacement material, obtained by removing a “cylindrical” section from the ascending aorta of the same patient, is fashioned into three cusps which are sutured into proper position to form the valve. The deficiency of the ascending aorta is then replaced by a plastic sleeve graft.Also presented is the history of the first patient on whom this operation was performed. He was a 40 year old accountant with severe aortic stenosis and left ventricular failure. Following operation he improved remarkably and was able to return to work. At times, however, he suffered from episodes of fever and chest pain. During three hospital admissions, repeated unsuccessful attempts were made to identify the organism causing the irregular fever. Despite cardiac and antibiotic therapy, death occurred seven months after operation. Necropsy showed the cause of death to be a recent myocardial infarct, possibly due to an embolus from an acute ulcerating bacterial (Klebsiella pneumoniae?) endocarditis which had developed upon the autologous grafted aortic valve.A remarkable transformation in the microscopic structure of the transplanted aortic wall then functioning as cusp tissue was observed. Speculation as to its possible significance raises exciting considerations. Is it degenerative or is it a metaplastic attempt to adjust to new functional requirements?The postoperative course in this case provides diagnostic and therapeutic clues that may prove valuable in preventing such an untoward outcome in future cases. |
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