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Replacement of the aortic valve after the arterial switch operation

Published online by Cambridge University Press:  18 April 2005

Vladimir Alexi-Meskishvili ,
Joachim Photiadis  and
Jan-Hendrik Nürnberg
Vladimir Alexi-Meskishvili
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
Joachim Photiadis
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
Jan-Hendrik Nürnberg
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
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Abstract

An 11-month-old infant had undergone a primary arterial switch operation, including the Lecompte maneuver, for correction of discordant ventriculo-arterial connections and closure of an accompanying ventricular septal defect.

At discharge, there were no signs of aortic valvar incompetence. Regurgitation across the aortic valve was detected first at the age of 2 years, and then increased progressively, as documented by serial echocardiographic studies. There had been no history of bacterial endocarditis. At the age of 10 years, echocardiography revealed severe aortic valvar incompetence. At operation, the aortic valve had three leaflets, all of which were short, with very restricted movement. Absence of sufficient leaflet tissue precluded a durable valvar reconstruction, so the aortic valve was replaced with a 21 mm mechanical prosthesis. Histological examination of the removed leaflets revealed nodular swelling due to mucous changes of the matrix, as well as fibrous alteration and formation of scar tissue, including areas of fibroblastic and capillary proliferation. There were no signs of calcification or acute inflammatory changes. Improvement of left ventricular function was observed both early postoperatively and later on. Our observation shows that aortic valvar incompetence after an arterial switch operation can be caused by degenerative changes of the neo-aortic leaflets, which prevent plastic reconstruction of the valve, necessitating valvar replacement.

Keywords

Neo-aortic valveJatene operationvalvar replacement
Type
Brief Report
Information
Cardiology in the Young , Volume 13 , Issue 2 , April 2003 , pp. 191 - 193
Copyright
© 2003 Cambridge University Press

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