Eur J Cardiothorac Surg 2005;27:1115
© 2005 Elsevier Science NL
Images in cardio-thoracic surgery |
Obstructive thrombosis of an aortic root homograft
Steven Laga*,
Bart Meuris,
Roland Demeyere,
Willem Flameng
Department of Cardiac Surgery, University Hospitals Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
Received 11 December 2004;
received in revised form 10 February 2005;
accepted 21 February 2005.
* Corresponding author. Tel.: +32 16 344260; fax: +32 16 344616. (E-mail: steven.laga{at}uz.kuleuven.ac.be).
Key Words: Homograft • Thrombosis • Aortic valve
A 57-year-old female presented with a dysfunctional aortic valve homograft, 8 years after root replacement for endocarditis. Echocardiography demonstrated grade 3 insufficiency with elevated gradients. Explantation revealed a large thrombus lodged in the right coronary cusp, causing right coronary ostium occlusion and partial left main stem stenosis (Figs. 1 and 2).
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Fig. 1. Angiography shows large cloud-like masses (white arrows) at the base of the aortic homograft (left), occluding the right coronary ostium. Calcification of the homograft is absent. Injection in the left main stem shows a large inconsistent stenosis (white arrow), suggestive for thrombus (right). The distal coronaries are free from atherosclerotic disease.
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Fig. 2. Intraoperative transesophageal two-dimensional echocardiogram (left) at long-axis view shows a closed mitral valve, closing of the noncoronary cusp of the aortic homograft (white arrow) and an immobilised right coronary cusp by thrombus (black arrow). Short-axis view of the aortic homograft at basal level (right) reveals a large thrombotic mass (black arrow). The aortic commissures are marked with a black triangle ( ). RA, right atrium; LA, left atrium; MV, mitral valve; LVOT, left ventricular outflow tract; RV, right ventricle.
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