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We performed prosthetic valve replacement with skirt in 11 patients for the fragile valvular annulus. Subjects included 6 patients with active infective endocarditis involving aortic root abscess, 2 patients with systemic disease requiring steroid treatment, and 3 patients with hemolysis or perivalvular leakage. Operative procedure in 11 patients was performed aortic valve replacement with Dacron or Xenomedica skirt attached to the prosthetic ring. One patient died of heart failure during perioperative period. 2 patients died of arrhythmia, heart failure in late postoperative period. The event free rate was 77.1% since 5 years after operation. We conclude that prosthetic valve replacement with skirt is useful to tha fragile valvular annulus.

Two patients with aortic root abscess were successfully treated with a fringed valve prosthesis, in which a fringe material was secured to the sewing cuff of a bileaflet prosthetic valve using a 4-0 running suture. This fringed valve technique provides dual security for annular attachment of the prosthesis without coronary reimplantation. Good late outcome suggests it would be a useful alternative for aortic root abscess.

Comparison of long term clinical results after aortic valve replacement with 19 mm or 21 mm vs. 23 mm or larger bileaflet prostheses has not yet been reported. Between December 1979 and September 1993, 80 consecutive patients who underwent isolated aortic valve replacement at Niigata University using a standard St. Jude Medical valve were assigned to small size group (19 mm and 21 mm, n = 34) or to large size group (23 mm or larger, n = 46). In the small size group, patient's age was older, body surface area smaller, female patients and calcified aortic stenosis were dominant (all p < 0.01). The left ventricular systolic dimension was shorter (p < 0.001), while the cardiothoracic ratio was similar to that of the large size group. All patients received warfarin treatment, and target thrombotest level was 15 to 25% (equivalent to INR 1.6 to 2.1). Actuarial survival rates including hospital death in the small size group (94% at fifth postoperative year) were comparable to those in the large size group. Cerebrovascular event occurred in two patients with the small size prosthesis (1.3%/pty) and three with larger prosthesis (0.9%/pty). Major hemorrhagic complication was not observed in either group. No significant difference was noticed in the proportion free from valve-related morbidity. In the patients with aortic stenosis (n = 41), the left ventricular posterior wall thickness decreased from 15 mm preoperatively to 11 mm late post surgery in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

We reported a patient of 46-year-old man, who had undergone reinforced aortic valve replacement using a composite Björk-Shiley prosthesis for infective endocarditis on April 13, 1988. Because of recurrent periannular endocarditis and periprosthetic dehiscence, reoperation was undertaken eighteen months after the initial operation. Following debridement, a composite Dacron vascular prosthesis with a St. Jude Medical valve and two saphenous vein grafts were transposed in the ascending aorta. The operative procedures were entirely smooth. A modified Danielson's technique may be adequate for recurrent periannular endocarditis which make orthotopic re-replacement impossible in most cases.

A 58-year-old woman was admitted to our hospital suffering from repeated chest pain. Selective coronary angiography (CAG) showed severely stenotic lesion in the left main coronary artery. There was no additional lesion in the left anterior descending and circumflex arteries. Aortography showed severe calcification in the aortic valve. The aortic was incised and divided completely at the aortic root 1 cm distal to the aortic valve. The incision was then extended toward the opening of the left coronary artery. An atheromatous plague was found and resected at the ostium. A saphenous vein patch was used to enlarge the internal diameter of the artery. The aortic valve was replaced using #21 SJM prosthetic valve. The patient recovered the surgery well, and anginal attacks have disappeared. Postoperative coronary angiograms revealed no stenotic lesion in the left main coronary artery.