Aortic valve replacement with autogenous aortic wall

Abstract

A new operation for replacement of the severely diseased aortic valve is described. The replacement material, obtained by removing a “cylindrical” section from the ascending aorta of the same patient, is fashioned into three cusps which are sutured into proper position to form the valve. The deficiency of the ascending aorta is then replaced by a plastic sleeve graft. Also presented is the history of the first patient on whom this operation was performed. He was a 40 year old accountant with severe aortic stenosis and left ventricular failure. Following operation he improved remarkably and was able to return to work. At times, however, he suffered from episodes of fever and chest pain. During three hospital admissions, repeated unsuccessful attempts were made to identify the organism causing the irregular fever. Despite cardiac and antibiotic therapy, death occurred seven months after operation. Necropsy showed the cause of death to be a recent myocardial infarct, possibly due to an embolus from an acute ulcerating bacterial ( Klebsiella pneumoniae?) endocarditis which had developed upon the autologous grafted aortic valve. A remarkable transformation in the microscopic structure of the transplanted aortic wall then functioning as cusp tissue was observed. Speculation as to its possible significance raises exciting considerations. Is it degenerative or is it a metaplastic attempt to adjust to new functional requirements? The postoperative course in this case provides diagnostic and therapeutic clues that may prove valuable in preventing such an untoward outcome in future cases.