Calcific Degeneration of CorMatrix 4 Years After Bicuspidization of Unicuspid Aortic Valve Zahra Mosala Nezhad, MD, PhD, Pamela Baldin, MD, Alain Poncelet,

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Calcific Degeneration of CorMatrix 4 Years After Bicuspidization of Unicuspid Aortic Valve Zahra Mosala Nezhad, MD, PhD, Pamela Baldin, MD, Alain Poncelet, MD, PhD, Gebrine El Khoury, MD The Annals of Thoracic Surgery Volume 104, Issue 6, Pages e431-e433 (December 2017) DOI: 10.1016/j.athoracsur.2017.07.040 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Gross features of the patch at initial operation and reoperation. (A) The anatomical presentation of the unicuspid valve. (B and C) CorMatrix (CorMatrix Cardiovascular, Roswell, GA) patch being hydrated and fashioned to suture into the annulus and create a 180-degree/180-degree bicuspid valve. (D) CorMatrix patch in situ with complete patch retraction and calcification. The Annals of Thoracic Surgery 2017 104, e431-e433DOI: (10.1016/j.athoracsur.2017.07.040) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Photomicrographs of the native and degenerate aortic valve. (A) Native cusp with chronic inflammation (hematoxylin and eosin [H&E]; original magnification ×10). (B) The entire extended cusp (circle) with heavily dystrophic calcified and fibrotic tissue (H&E; original magnification ×10). (C) Trichrome stain (original magnification ×2) showing fibrosis. (D) Macrophage infiltration into the dystrophic and degenerate valve (immunohistochemistry with anticluster of differentiation 68 [CD68] antibodies; original magnification ×10). The Annals of Thoracic Surgery 2017 104, e431-e433DOI: (10.1016/j.athoracsur.2017.07.040) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions