title: Severe aortic regurgitation after implantation of a sutureless valve prosthesis using an automatic knot fastener device.
abstract: We report the case of severe aortic regurgitation 8 months after implantation of a 25-mm sutureless pericardial aortic valve prosthesis. On echocardiography, the regurgitation was suspected to be paravalvular. The sutureless prosthesis had been implanted using an automatic knot fastener device, which renders the suture tails less pliable because of the metal clip that is crimped around the suture. The patient was reoperated, a paravalvular leak was not observed. The sutureless prosthesis was explanted and a conventional biologic valve prosthesis was implanted instead. On examination of the explanted valve prosthesis, a perforation was observed in one of the leaflets. The leaflet perforation was in alignment with one of the knots produced by the automatic knot fastener. Obviously, the leaflet had hit the knot repeatedly which had caused the perforation. We conclude that knots produced by an automatic fastener device have the potential to cause leaflet perforation.
authors.affiliation: Department of Cardiac Surgery, Klinikum Passau, Passau, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Balan
authors.affiliation: Department of Cardiac Surgery, Klinikum Passau, Passau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Mogilansky
authors.affiliation: Department of Cardiac Surgery, Klinikum Passau, Passau, Germany.
authors.forename: Axel-Lars
authors.initials: AL
authors.lastname: Larsen
authors.affiliation: Department of Cardiac Surgery, Klinikum Passau, Passau, Germany.
authors.forename: Parwis
authors.initials: P
authors.lastname: Massoudy
mesh_terms: D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000601:surgery; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012720:Severity of Illness Index; D013536:Suture Techniques / Q000295:instrumentation*
keywords: Aortic regurgitation; COR-KNOT; Sutureless Valve