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Based on a review of the literature and on a personal series of 136 cases the reliability of echocardiography and Doppler echocardiography in demonstrating aortic stenosis and regurgitation and its value for the analysis of aortic valve prosthesis is investigated.

Introduction: In the past years the numbers of transcatheter aortic valve implanation (TAVI) procedures performed have increased exponentially. With increasing numbers even rare complications of this relatively new technique were identified. Aim of this study was to analyze incidence of ventricular septum defect (VSD) after TAVI. Methods: A total of 510 high risk patients treated by TAVI through our interdisciplinary heart team were analyzed. Results: 4/510 (0.8%) patients (2 female, EuroSCORE: 20 ± 6%; STSscore: 5 ± 2%) suffering VSD after TAVI (Transfemoral = 3, Transapical = 1) procedure were identified. Three patients had received balloon expandable Edwards Sapien (1), Sapien XT (2) valves and one patient a self expandable valve (Symetis Accurate). In two patients postdilatation was performed due to severe aortic insufficiency during procedure leading to VSD. Postprocedural echocardiography and angiography revealed in a mild VSD in one patient with no further treatment and moderate/severe VSD in three patients. One patient received a second transcatheter valve, which was implanted transapically leading to VSD occlusion. Two patients received conventional aortic valve replacement due to severe aortic regurgitation with patch occlusion of the VSD. In all cases postinterventional echocardiography revealed a sufficient aortic valve prosthesis without VSD. One patient unfortunately died on POD six due to AV-Block III. All other patients survived. Conclusion: VSD after TAVI is a rare and unusual complication. It seems to be independent from different valve models but may be related to excessive calcifications. Further therapy consisting of a second TAVI procedure or surgical correction is warranted and leads to acceptable outcomes.

Seven patients with bacterial endocarditis have been treated at the Department of Pediatric Cardiology University Gottingen from September 1975 to July 1978. All of them had congenital heart defects considered as a predisposing condition and confirmed by previous cardiac catheterization, three patients were cyanotic. Unlike the spectrum of micro-organisms prevalent hitherto Pseudomonas aeruginosa was isolated in three cases. In one of these patients antibiotic drug therapy was unsuccessful and only surgical management with closure of the rest-VSD and excision of the endocardiac lesions was finally helpful. Another patient died and Pseudomonas aeruginosa endocarditis was disclosed by post mortem examination only. The onset of symptoms in four patients was less than six months after cardiac surgery. In two cases aortic valve prosthesis became necessary. No relapse during the further follow up period was observed.

Implantation of an aortic valve prosthesis in patient with aberrant left circumflex coronary artery arising from the initial portion of the right coronary artery resulted in compression of this vessel by the prosthetic valve and in pump failure after interruption of cardiopulmonary bypass. Incidence and significance of variations in coronary artery origin and course are mentioned.

The case history and pathomorphological findings of a very rare fatal complication following prosthetic heart valve replacement are described: A 51-year-old woman died of acute malfunction of her Björk-Shiley aortic valve prosthesis caused by a large embolus deriving from the left atrium. After triple valve replacement 30 months earlier she seemed to be in good health. She had been subject to absolute arrhythmia for many years, and anticoagulation treatment had been felt to be sufficient.