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(Circulation. 2007;115:e197-e199.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Apicoaortic Double-Valved Conduit in a 40-Year-Old Woman

Sanjay Sarin, MD; Anwer Qureshi, MD; Jamshid Shirani, MD

From the Department of Cardiology, Geisinger Medical Center, Danville, Pa.

Correspondence to Sanjay Sarin, MD, Geisinger Medical Center, 100 North Academy Ave, Danville, PA 17822–2160. E-mail ssarin1{at}geisinger.edu

A 40-year-old woman was admitted with pneumonia and septic shock. Chest x-ray showed bilateral pulmonary infiltrates, cardiomegaly, and a bioprosthetic valve in an unusual position near the left ventricular apex (Figure 1A). The patient had a history of muscular subaortic stenosis. At age 4, she underwent surgical resection, but severe subaortic stenosis recurred 5 years later when an apicoaortic conduit containing an Ionescu–Shiley bioprosthetic valve was placed between the left ventricular apex and the descending thoracic aorta. Six years later, a 22-mm St. Jude mechanical prosthesis was also inserted within the apicoaortic conduit, distal to the malfunctioning (regurgitant) Ionescu–Shiley prosthesis.

View larger version (76K): [in this window] [in a new window]   Figure 1. A, Chest roentgenogram in anteroposterior view showing cardiomegaly and bilateral pulmonary infiltrates. The Ionescu–Shiley pericardial bioprosthesis (1) is identified by a radiopaque valve ring at the left lateral border of the heart. B and C, Cross-sectional computerized tomographic view of the heart showing the apicoaortic conduit (*) containing the Ionescu–Shiley pericardial bioprosthesis (1) proximal to a St. Jude mechanical prosthesis (2). AO indicates aorta (descending); LV, left ventricle.

Transesophageal echocardiography showed a patent conduit containing a normally functioning St. Jude prosthesis, with no evidence of endocarditis (Figure 2). A cardiac computed tomography scan clearly showed the proximally placed Ionescu–Shiley and distally placed St. Jude prostheses (Figure 1B and 1C).

View larger version (59K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiographic views of the heart and aorta. A, Origin of the conduit at the left ventricular (LV) apex (*) (Movie I). B, Flow acceleration at the LV apex in systole by color flow Doppler (Movie II). C, Distal insertion of the conduit (*) into descending thoracic aorta (AO) (Movie III). The St. Jude mechanical prosthesis (2) has produced intense acoustic signal. D, Systolic flow through the apicoaortic conduit into the descending thoracic aorta by color flow Doppler (Movie IV).

Apicoaortic valved conduit (or aortic valve bypass) surgery has been used to create alternative left ventricular outflow in patients with complex pathology, small aortic annulus, calcified or porcelain aorta, multiple prior sternotomies, or como-bidities. The conduit connects the left ventricular apex to the descending thoracic aorta through left thoracotomy, without the need for cardiopulmonary bypass. Single-center experience with this type of surgery has been limited.^1,2 To our knowledge, no patient with a double-valved apicoaortic conduit has been reported before.

	Disclosures

Top Disclosures References

 
None.

	Footnotes

 
The online-only Data Supplement, consisting of Movies I through IV, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/7/e197/DC1.

	References

Top Disclosures References

 
1. Renzulli A, Gregorio R, De Feo M, Ismeno G, Covino FE, Cotrufo M. Long-term results of apico-aortic valved conduit. Tex Heart Inst J. 2000; 27: 24–28.[Medline] [Order article via Infotrieve]

2. Cooley DA, Lopez RM, Absi TS. Apicoaortic conduit for left ventricular outflow tract obstruction: revisited. Ann Thorac Surg. 2000; 69: 1511–1514.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sarin, S. Articles by Shirani, J. Search for Related Content PubMed PubMed Citation Articles by Sarin, S. Articles by Shirani, J. Related Collections Valvular heart disease CT and MRI Echocardiography CV surgery: aortic and vascular disease CV surgery: valvular disease