CoreValve® EvolutTM R 23 for the treatment of severe regurgitation in a Mitroflow® 21 prosthesis

Case presentation An 81-year-old man was admitted to our institution with symptoms and signs consistent with acute lung oedema. He had a history of hypertension and hypercholesterolaemia and had undergone cardiac surgery in July 2005 due to severe aortic stenosis and three vessels disease. Coronary artery bypass grafting (CABG) with a saphenous vein graft (SVG) to left anterior descending (LAD) and a sequential SVG to first and second obtuse marginal branches (OM) were performed. Distal right coronary artery (RCA) was diffusely diseased and non-grafted. A Mitroflow® 21 (Sorin S.p.A, Milan, Italy) was implanted in aortic position. In August 2005 he had a permanent dual-chamber, ratemodulated pacing (DDDR) pacemaker implanted due to bradycardia–tachycardia syndrome, and in September 2005 he underwent percutaneous coronary intervention (PCI) and stenting of the proximal SVG–OM anastomosis. He had been well until 3 weeks prior to the current presentation, when progressive effort dyspnoea developed following an upper respiratory tract infection.