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Review
. 2017 Jun 20;23(3):157-160.
doi: 10.5761/atcs.cr.16-00183. Epub 2016 Dec 14.

Pure Cusp Tear of Trifecta Bioprosthesis 2 Years after Aortic Valve Replacement

Masaki Hamamoto  1 , Taira Kobayashi  1 , Masamichi Ozawa  1 , Kosuke Yoshimura  1
Affiliations
Review

Pure Cusp Tear of Trifecta Bioprosthesis 2 Years after Aortic Valve Replacement

Masaki Hamamoto et al. Ann Thorac Cardiovasc Surg. .

Abstract

Trifecta is a stented bioprosthetic heart valve with a bovine pericardial sheet externally mounted on a titanium stent. This valve is applied only for aortic valve replacement (AVR), providing excellent hemodynamics and extremely low incidence of structural valve deterioration (SVD). A 76-year-old woman presented with dyspnea on effort 24 months after AVR with a 21-mm Trifecta valve. Echocardiography revealed severe aortic regurgitation with prolapse of a cusp of Trifecta valve, which suggested that she developed acute heart failure due to early SVD. In the operation, Trifecta valve had a cusp tear near the commissure with circumferential fibrous pannus ingrowth only at the inflow side. There was neither calcification nor infection. The Trifecta valve was successfully replaced with a new porcine bioprosthesis.

Keywords: Trifecta; aortic valve replacement; pericardial bioprosthesis; structural valve deterioration.

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Figures

Fig. 1
Fig. 1. (A) Chest X-ray showing lung congestion and enlargement of cardiac shadow. (B) Transesophageal echocardiography showing prolapse of a cusp of the Trifecta bioprosthesis (arrow in the left panel) and eccentric regurgitant jet (right panel). Ao: ascending aorta; LA: left atrium; LV: left ventricle
Fig. 2
Fig. 2. Photographs of the explanted Trifecta bioprosthesis. (A and B) Outflow surface of the Trifecta valve showing parastent post tear from the commissure down to the belly along the stent post (white arrowhead). (C) Inflow surface of the Trifecta valve showing pannus overgrowth (white arrow).
See this image and copyright information in PMC

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