A 69-year-old female patient underwent aortic root replacement with stentless bioprosthesis for extensive endocarditis. Two years later, she presented with exertional dyspnoea. Transoesophageal echocardiography and ventriculography revealed a 60-mm pseudo-aneurysm of the left ventricle outflow tract (Figs. 1 and 2 ). The patient underwent successful aortic root replacement with allograft.
Left ventriculography shows displacement of the prosthesis from the native aortic annulus. During the first surgery, the valve was implanted by putting interrupted Ethibond 3/0 suture and then a continuous 4/0 polypropylene suture re-enforced with pericardial patch. During the surgery it was noted that suture was mainly on the implant side. AA: ascending aorta; LV: left ventricle; RV: right ventricle; PsA: pseudo-aneurysm; Pt: stentless aortic root prosthesis.
Left ventriculography shows displacement of the prosthesis from the native aortic annulus. During the first surgery, the valve was implanted by putting interrupted Ethibond 3/0 suture and then a continuous 4/0 polypropylene suture re-enforced with pericardial patch. During the surgery it was noted that suture was mainly on the implant side. AA: ascending aorta; LV: left ventricle; RV: right ventricle; PsA: pseudo-aneurysm; Pt: stentless aortic root prosthesis.
Transoesophageal echocardiography shows a complete detachment of aortic root bioprosthesis that was displaced approximately 50 mm from the native annulus with a pseudo-aneurysm reaching a maximum diameter of 60 mm. We postulate that the mechanism of disconnection might be due to extreme trimming of the periannular tissue during the debridement of the endocarditis mass, and the suture into the loose muscular tissue could have resulted in eventual loss of integrity of the anastomosis. LV: left ventricle; RV: right ventricle; LA: left ventricle PsA: pseudo-aneurysm; Pt: stentless aortic root prosthesis.
Transoesophageal echocardiography shows a complete detachment of aortic root bioprosthesis that was displaced approximately 50 mm from the native annulus with a pseudo-aneurysm reaching a maximum diameter of 60 mm. We postulate that the mechanism of disconnection might be due to extreme trimming of the periannular tissue during the debridement of the endocarditis mass, and the suture into the loose muscular tissue could have resulted in eventual loss of integrity of the anastomosis. LV: left ventricle; RV: right ventricle; LA: left ventricle PsA: pseudo-aneurysm; Pt: stentless aortic root prosthesis.
