A 34-year-old gentleman presented with Staphylococcus salivarius infective endocarditis 13 years after aortic homograft and mitral valve repair for degenerative bicuspid aortic valve associated with rheumatic heart disease. The homograft had calcified, and the mitral repair had deteriorated with severe regurgitation. Multidisciplinary team decision to restore best quality of life was for re-do Ross procedure with bi-leaflet preserving mitral valve replacement with an inverted RESILIA aortic valve as the patient was fundamentally against lifelong anti-coagulation. The aortic homograft was excised, and coronary arteries dissected out followed by harvesting of the pulmonary autograft. The mitral valve was accessed via a trans-septal approach. On examination, there was a restricted and thickened posterior mitral valve leaflet. An inverted 27-mm INSPIRIS RESILIA aortic bio-prosthesis was placed with mitral cusps preserved. The pulmonary autograft was implanted in an intra-annular position, and a 26-mm pulmonary homograft was used to replace the pulmonary valve. Echocardiogram at 4 weeks revealed preserved LV function and well-functioning prosthetic, autograft and homograft. An inverted RESILIA valve, with its anti-structural valve deterioration properties, can be used in the mitral position with preservation of the mitral cusps to avoid anti-coagulation with the hope of reducing need for re-operation in line with patient wishes.

中文翻译：

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反向主动脉生物假体用于Ross手术置换二尖瓣：病例报告

一名34岁的绅士在主动脉同种异体移植和二尖瓣修复与风湿性心脏病相关的退行性双尖瓣主动脉修复13年后出现了唾液葡萄球菌感染性心内膜炎。同种异体钙化，二尖瓣修复因严重的反流而恶化。多学科团队决定恢复最佳生活质量的原因是，通过双瓣再行Ross手术，保留二尖瓣置换术并用RESILIA主动脉瓣置换术，因为患者从根本上反对终生抗凝治疗。切下主动脉同种异体移植物，解剖出冠状动脉，然后收集肺部自体移植物。二尖瓣经隔隔入路。检查时，二尖瓣后叶小而狭窄。放置一个倒置的27毫米INSPIRIS RESILIA主动脉生物假体，保留二尖瓣。将肺自体移植物植入环内位置，并使用26毫米肺同种异体移植物替代肺动脉瓣。4周时的超声心动图显示左心室功能得以保留，假体，自体移植物和同种异体移植物功能良好。倒置的RESILIA瓣膜具有抗结构瓣膜恶化的特性，可以在二尖瓣位置使用，并保留二尖瓣尖以避免反凝结，从而希望减少根据患者意愿进行再次手术的需要。4周时的超声心动图显示左心室功能得以保留，假体，自体移植物和同种异体移植物功能良好。倒置的RESILIA瓣膜具有抗结构瓣膜恶化的特性，可以在二尖瓣位置使用，并保留二尖瓣尖以避免反凝结，从而希望减少根据患者意愿进行再次手术的需要。4周时的超声心动图显示左心室功能得以保留，假体，自体移植物和同种异体移植物功能良好。倒置的RESILIA瓣膜具有抗结构瓣膜恶化的特性，可以在二尖瓣位置使用，并保留二尖瓣尖以避免反凝结，从而希望减少根据患者意愿进行再次手术的需要。