Intra-annular Leak of a Pericardial Prosthetic Valve

摘要

A 61-year-old man with a bicuspid aortic valve had aortic insufficiency and an ascending aortic aneurysm. Accordingly, composite aortic root replacement was performed. A 27-mm pericardial valve was incorporated into a 32-mm polyester graft into which coronary buttons were implanted. Intraoperative color Doppler interrogation revealed a leak along the closure line of what was the new left coronary cusp. The jet originated along the entire edge of the cusp and extended 2 cm into the ventricle. A smaller leak occurred between the cusps in the right and noncoronarypositions. What is the mechanism of the prosthetic regurgitationillustrated in Fig 1?