Natural History of a Carpentier-Edwards Pericardial Aortic Valve Replaced after 25 Years for Structural Valve Degeneration

Figures

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  Figure 1. Transesophageal echocardiography performed in 2018 showing thickened valve leaflets but without major restricted prosthetic valve opening (A) and closure (B). The prosthetic valve effective orifice area is calculated at 1.2 cm2 using the continuity equation method (A). Continuous-wave Doppler across the bioprosthesis showing peak and mean gradients of, respectively, 20 and 11 mm Hg at a heart rate of 74 beats/min (C). The prosthetic valve geometric orifice area is measured at 1.3 cm2 by planimetry (D). Mild to moderate intraprosthetic regurgitation at diastole (E). Root and AA aneurysms measured at 48 and 53 mm, respectively (F). LA, Left atrium; LV, left ventricle.

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  Figure 2. Transesophageal echocardiography performed in February 2020 showing markedly thickened leaflets with a partial disinsertion of the NC leaflet on two-dimensional and three-dimensional (blue arrow) imaging (A,B), resulting in severe intraprosthetic regurgitation (C, D).

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  Figure 3. Chest computed tomography showing the AA aneurysm. PA, Pulmonary artery.

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  Figure 4. Explanted Carpentier-Edwards pericardial aortic bioprosthesis with pannus overgrowth and fibrosis in the sewing ring. We can also see thickened valve leaflets with a disinsertion of the base of the NC leaflet (black arrow; A–C). Postoperative transesophageal echocardiography showing AVR with a normal functioning bioprosthesis and the replacement of the NC sinus and the AA with a Dacron graft (D,E). LA, Left atrium; LV, left ventricle.