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Kathryn L. O'Keefe, MD, Stephen D. Cohle, MD, Jeremiah E

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Presentation on theme: "Kathryn L. O'Keefe, MD, Stephen D. Cohle, MD, Jeremiah E"— Presentation transcript:

1 Early Catastrophic Stentless Valve Failure Secondary to Possible Immune Reaction 
Kathryn L. O'Keefe, MD, Stephen D. Cohle, MD, Jeremiah E. McNamara, BS, Robert L. Hooker, MD  The Annals of Thoracic Surgery  Volume 91, Issue 4, Pages (April 2011) DOI: /j.athoracsur Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Low-power view taken near the xenograft anastamosis. The area between the arrows exhibits extensive granulation tissue with chronic inflammation. (*Denotes xenograft tissue.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 High-power view of Figure 1, showing granulation tissue and multi-nucleated giant cell (arrow). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Coronary angiography with ostial left main lesion.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Injection of the aortic root demonstrating no coronary flow.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Right sinus of Valsalva and stenosed ostium of the right coronary button (arrow). There is dense neointimal hyperplasia covering much of the xenograft intimal surface (*), extending down into the coronary ostium. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Medium-power view of xenograft (*) and native aorta (**) anastamosis. Arrows denote giant cells surrounded by a dense inflammatory reaction and area of neointimal hyperplasia. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Anastamosis of xenograft and right coronary button. Severe neointimal hyperplasia as a result of inflammation (*). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

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