Wall rupture of Medtronic Freestyle stentless porcine aortic root bioprosthesis

The Medtronic Freestyle stentless bioprosthetic valve provides excellent hemodynamics and long-term durability. However, several studies have reported mid-term structural valve deterioration unique to cases of Freestyle bioprosthesis implantation. According to these reports, the degeneration of the porcine aortic wall causes the dilatation and disruption of the sinus of Valsalva. We encountered a very rare case of an 8 mm-long tear located just above the inflow end of the Dacron cloth. The sudden rupture of the bioprosthetic aortic wall formed a pseudoaneurysm that compressed and almost occluded the pulmonary artery leading to low cardiac output syndrome and shock.