A Case of Severe Aortic Regurgitation Caused by Fissured Aortic Cusps Reconstructed with Autologous Pericardium

Abstract

An 82-year-old woman was hospitalised in our institution because of worsening dyspnoea on effort. She had a history of aortic valve reconstruction with autologous pericardium (AVrC) for severe aortic stenosis 1 year and 9 months ago. Her transthoracic echo examination revealed that she had severe aortic regurgitation with preserved left ventricular systolic function. Compared with her previous echo findings shortly after AVrC, her left ventricle was clearly dilated with newly detected moderate mitral regurgitation. Transoesophageal echo was performed for further investigation, which showed that, in particular, her right coronary cusp (RCC) was obviously prolapsed toward the left ventricular outflow tract with wide aortic regurgitant jet. After conservative medical therapy, aortic valve replacement and mitral annular plasty were performed. Her removed autologous aortic cusps clarified the details: not only did the RCC, but also left coronary cusp have two clefts on both ends of each cusp, and the non–coronary cusp had one fissure on one end. Her symptoms improved dramatically after aortic valve replacement. Aortic valve reconstruction with autologous pericardium is characterised by excellent valvular durability with a low mortality. However, the patient in this case suffered from rapid deterioration of the reconstructed autologous aortic valve. According to a previous report, one AVrC case was required reoperation due to aortic regurgitation caused by prolapse of RCC, which was the same cusp as in this case. Autologous RCC for AVrC is usually the smallest and made from thinner side of pericardium. This may be the reason why RCC is the culprit cusp when aortic regurgitation occurs shortly after AVrC.