*2.3.1 Technique of aortomitral homograft implantation*

1.After the transverse aortotomy, the inspection of aortic valve revealed total leaflet destruction, vegetation, and abscess cavity on the level of aortic annulus. The valve was excised, and total root debridement was performed in order to get rid of infected and necrotic masses. Then deep mobilization of the aortic root, excision of valsalva sinus, and coronary arteries mobilization. From the middle of the noncoronary sinus, an incision was made down to the anterior mitral valve leaflet. The left atrial roof was opened. For better exposure of the mitral

*Clinical Implication of Cardiac Valve Allografts in Rare Surgical Circumstances DOI: http://dx.doi.org/10.5772/intechopen.112865*

#### **Figure 2.** *The final view. Inferior vena cava replaced by pulmonary allograft.*

valve, the incision of the left atrium can be extended by dissecting the interatrial septum and the right atrium (**Figure 3**).


Cardiopulmonary bypass time was 235 minutes; myocardial ischemia time was 210 minutes. The patient was in the intensive care unit for 3 days and in the hospital

#### **Figure 3.**

*Aortic and mitral valve are excised. The incision of the left atrium is extended by dissecting the interatrial septum and the right atrium.*

**Figure 4.** *The aortomitral homograft is fixed in the mitral position.*

*Clinical Implication of Cardiac Valve Allografts in Rare Surgical Circumstances DOI: http://dx.doi.org/10.5772/intechopen.112865*

#### **Figure 5.**

*The aortic part of the homograft is inserted into the left ventricle (LV cavity) and is sewn into the aortic root position.*

for 12 days. In the postoperative period, the patient underwent echocardiography assessment and was discharged from the hospital with excellent homograft function.

### **2.4 Concomitant homograft mitral valve replacement and aortic autopericardial neo-cuspidalization in patient with Bekhterev's disease**

A 52-year-old woman with Bekhterev's disease was admitted to the Department of Cardiac Surgery ("Sechenov University") for elective aortic and mitral valve surgery. On admission, the patient's clinical status was presented with pronounced dyspnea at rest, cough, increased fatigue, and moderate pain in the heart area. From the past medical history, we found out that the first manifestation of Bekhterev's disease occurred at the age of 25 with iridocyclitis, which at that time was regarded as a manifestation of herpes-virus infection. At age 42, the presence of the HLA B-27 gene was laboratory confirmed. Back in those days, mild-to-moderate mitral regurgitation was revealed. Four years later, at the age of 46, transthoracic echocardiography showed mild aortic regurgitation. Sulfasalazine was first prescribed in a dosage of 1 g two times a day. In 2022, at the age of 52, after a coronavirus infection, patient's condition went to decline with increased dyspnea and swelling of the lower extremities. Heart auscultation revealed a diastolic murmur, mainly in the area of the aorta, and a systolic noise irradiating to the left axillary region. Spinal mobility was limited due to stiffness in the lower back and in the cervical region. Transthoracic echocardiogram showed enlarged LV (LV end-diastolic diameter 57 mm, end-diastolic volume 190 ml), LV EF at rest 58%,

**Figure 6.** *Posterior partial ring mitral homograft annuloplasty is performed. Final view.*

thickened aortic root wall, marginal fibrosis of aortic valve cusps, right coronary cusp thickened, central coaptation defect, and restricted leaflet motion. The mitral valve leaflets were thickened with restricted motion as well. The doppler-echocardiography confirmed severe central aortic regurgitation and severe mitral insufficiency.
