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Background: Severe aortic valve stenosis is relatively more prevalent in patients with repeated bleeding episodes. The goal of the present study was to determine the effect of aortic valve replacement on von Willebrand factor levels in patients with aortic stenosis. Methods: Von Willebrand factor levels were assessed by using immunoblotting electrophoresis techniques before and 1 month after surgery in 29 consecutive patients with severe aortic valve stenosis. Results: Eight of 29 patients reported episodes of bleeding, including three episodes of major bleeding, in the 6 months before surgery. None of the patients were receiving anticoagulation therapy. Although there was no difference in platelet count before and after surgery, von Willebrand factor levels were significantly greater at 1 month after surgery (p = 0.05) when compared with preoperative values. Further, von Willebrand factor levels were significantly lower in patients with aortic valve prosthesis mismatch than in those patients without this phenomenon (p < 0.05). Electrophoresis experiments showed a deficit in large multimers of von Willebrand factor preoperatively but not postoperatively, except for in those patients with aortic valve prosthesis mismatch. Conclusions: In conclusion, valve replacement can result in increases in von Willebrand factor in patients with aortic valve stenosis. [Copyright &y& Elsevier]

The authors report the case of a 72-year-old woman with severe aortic stenosis who had a bleeding tendency develop due to type IIA acquired von Willebrand disease. She underwent aortic valve replacement with a 19-mm Freestyle stentless valve (Medtronic Inc, Minneapolis, MN). The postoperative course was uneventful and the bleeding tendency resolved. A review of this operative case from our institution demonstrated that aortic valve replacement was one of the most effective treatments of this disease, which can be potentially lifesaving. [Copyright &y& Elsevier]

Aortobronchial fistula (ABF) is a rare condition that is almost always fatal in the absence of prompt and proper treatment. However, treatment remains challenging, particularly in the aortic arch. We present six operations for 5 such patients, in which no in-hospital deaths occurred. One patient with mycotic aneurysm died suddenly 10 months postoperatively. Another patient required reoperation 5-months after operation due to additional ABF. No pseudoaneurysms or graft-related complications were observed in the remaining patients. In patients with ABF, performance of operations as soon as possible after onset and minimal dissection of adherent lung tissue appear to improve outcomes. [Copyright &y& Elsevier]