Everted leaflet of a bovine pericardial aortic valve

We report on an everted leaflet of a Carpentier-Edwards Perimount (CEP) valve in an aortic position. A 71-year-old female patient with aortic regurgitation underwent valve replacement with a 21-mm CEP valve. After aortic declamping, transesophageal echocardiography (TEE) revealed significant transvalvular regurgitation due to an immobilized non-coronary leaflet. Upon re-aortotomy, we found an everted leaflet without any structural damage to the valve. It was readily corrected and eversion did not recur spontaneously. The valve was not replaced because it had no intrinsic problems, eversion was unlikely to be induced by cardiac output, and there was no evidence that re-implantation would avoid further problems. Her postoperative course was uneventful without recurrence of aortic regurgitation during three months of follow-up after surgery. On TEE measurements, allocation of stent posts was slightly uneven. Since leaflet eversion was re-created by distortion of the stent in an ex-vivo model, a mild imbalance of sutures might increase the risk of this event. TEE was beneficial for detection, decision-making, and avoidance of an early reoperation. This case indicates that reimplantation or replacement of the valve is not always necessary for an everted valve leaflet. Although the patient has had an uneventful course thus far, careful follow-up is mandatory.