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Case Reports

Subannular Perforation After Long-Lasting Aortic Valve Replacement Mimicking Mitral Insufficiency

^a Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
^b Department of Anesthesiology, University Hospital Cologne, Cologne, Germany

Accepted for publication July 24, 2007.

^_* Address correspondence to Dr Strauch, Department of Cardiothoracic Surgery, University Hospital of Cologne, Kerpener Str 62, Cologne, 50924, Germany (Email: ju.strauch{at}gmx.de).

We report a rare case of a patient diagnosed with mitral insufficiency grade III 12 years after mechanical aortic valve replacement. Transesophageal echocardiography discribed an eccentric mitral regurgitation-type systolic jet with color flow evidence of communication between left venticle and atrium. Surgical intervention showed a circular defect in the mitral-aortic intervalvular fibrosa area, after removal of the mechanical valve, located beneath the noncoronary sinus causing the echocardiography-detected mitral insufficiency. A pericardial patch was trimmed to the appropriate size, and the defect was closed. The aortic valve was replaced by a stented pericardial bioprosthesis.