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