Aortic valve replacement thirty-one months after orthotopic heart transplantation

Aortic valve replacement with a St. Jude prosthesis was performed 31 months after orthotopic heart transplantation in a 28-year-old male patient with Steinert's disease and idiopathic cardiomyopathy. The donor heart was reported as being normal by the cardiologist of the referring hospital. During implantation, a bicuspid aortic valve was noted, and early after the operation mild aortic regurgitation became apparent. Aortic incompetence advanced to a severe degree within 2 years after transplantation. Valve replacement, instead of retransplantation, was undertaken after careful consideration of the advantages and disadvantages of the therapeutic choice. This case report demonstrates the feasibility of valve replacement after heart transplantation and emphasizes the need for careful evaluation of potential donor hearts before harvesting.