*2.5.2 Surgical procedure*

Concomitant operation was performed through the medial sternotomy approach with standard cardiopulmonary bypass. The cryoablation procedure was carried before valve repair. TV inspection revealed severely dilated annulus, leaflet shrinkage, and thickening that was assumed to be not appropriate for successful repair. MA was chosen as a valve substitute. ASD was closed by means of a bovine pericardium patch of appropriate size. After several measures had been taken, MA was implanted in the tricuspid orifice. The procedure was accompanied by tricuspid ring implantation. Intraoperative echocardiography (ECHO) demonstrated no residual regurgitation on MA with mean diastolic pressure gradient of 2 mmHg.

#### **Figure 8.**

*ECG-gated cardiac CT reformation in interventricular septum plane before operation, mid diastole. Large ASD in the central part of interatrial septum.*

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

#### **Figure 9.**

*Short-axis steady-state free precession cardiac MRI in tricuspid plane, diastole. Homograft annulus after surgery. The dashed line indicates valve annulus with annuloplasty ring.*

#### *2.5.3 Postoperative follow-up*

Postoperative CCT demonstrated reduction in RV volumes with EF of 47%, RV FAC—34% and TAPSE—16 mm. Homograft orifice area was 9 cm2 and excellent leaflet coaptation was clearly seen (**Figure 9**). TTE demonstrated mean trans-homograft pressure gradient 1.4 mmHg, normal leaflet motion without regurgitation (**Figure 10**). Patient was discharged from the hospital with sinus rhythm and excellent homograft function. Oral anticoagulation therapy was stopped after a 3-month period of intake.
