Technical challenges and complications of double valve replacement in the presence of small aortic and mitral annuli.

A 57 year old female with rheumatic heart disease affecting both aortic and mitral valves underwent double valve replacement. The presence of small aortic and mitral annuli contributed to a series of intraoperative complications: left coronary ostium occlusion and type III atrioventricular groove disruption. The latter was repaired with a generous fresh autologous pericardial double layer patch and implant of a bileaflet mechanical prosthesis over the patch. Postoperatively, the patient developed prolonged respiratory insufficiency and pneumonia, transient myocardial dysfunction and acute renal failure. She was eventually discharged home without residual defects.