A case of floppy aortic valve following radical operation of tetralogy of Fallot
Saitoh, Y.; Masuda, A.; Umemoto, M.; Tanaka, K.; Nonoyama, A.; Kagawa, T.
Nihon Kyobu Geka Gakkai 33(10): 2000-2003
1985
ISSN/ISBN: 0369-4739 PMID: 4086895 Document Number: 258470
The patient was an 18-year-old high school girl with a chief complaint of dyspnea on exertion. The patient had undergone a Brock's operation at 8 months after birth as palliation for tetralogy of Fallot, which was followed by radical operation at the age of 6 years. During the latter operation, the non-coronary cusp of the aortic valve was damaged with a scalpel. The damage was then repaired by direct suture. However, cardiac murmur became audible from 2 years after the operation and aortography detected AR of the Sellers degree III. Subsequently the third open heart surgery was performed in Feb. 1978. This revealed a perforation of 8 .times. 4 mm in size in the non-coronary cusp of the aortic valve. The perforation was repaired by direct suture, again. Two years after the third surgery, the patient was rehospitalized due to development of heart failure. As aortography on admission revealed AR of the Sellers degree III and residual VSD (Qp/Qs: 1.4), the fourth open heart surgery was performed in Oct, 1983. This operation consisted firstly of closure of residual VSD and then of AVR using an mechanical valve (SJM: 21 mm). Histological examination of the resected valve demonstrated no specific inflammatory degeneration nor calcification but marked hyalinization and myxomatous degeneration of the entire valve. Remarkable deposition of acid mucopolysaccharides was identified by Alcian blue staining. On the basis of these findings, the diagnosis of floppy aortic valve was established. Floppy valve, though mostly seen in the mitral valve, is occasionally encountered in the aortic valve. Sometimes floppy valve is seen in the both valves. This suggests the possibility of future development of mitral complication in the present case. A careful follow-up is, therefore, required.