Local Erosions of a Bioprosthetic Aortic Valve Cusp Caused by Towering Ring Suture Knots Too Close to the Valve
A 75-year-old patient was referred to our clinic with the diagnosis of a grade III paravalvular aortic valve regurgitation 5 years after bioprosthetic aortic valve replacement with the SJM EPIC Valve bioprosthesis (St. Jude Medical Inc, St. Paul, Minn). During aortic valve replacement surgery, 2 local erosions in the right coronary cusp of the bioprosthetic aortic valve were detected (Figure, A and B), as well as a paravalvular leak. The location of the holes on the right prosthetic coronary cusp corresponded in the systolic cusp position to 2 adjacent sutures on the valve ring. It appeared that the erosions were caused by chronic irritation of the cusp from multiple knots that occurred during systolic motion of the cusp. The patient was treated with a bioprosthetic valve re-replacement. This case clearly demonstrates the great importance of precise annular knot placement away from the bioprosthesis during aortic valve replacement surgery.