Fourth Recurrence of Aortic Annular Dehiscence Following AVR for Aortic Regurgitation

It is a report of an unusual case of recurrent periprosthetic aortic regurgitation which occurred four times in the same patient over a span of 26 years. After pre-operative stabilization, the patient was subjected to a fifth open heart surgery to replace the 4th prosthetic aortic valve by an upsized 5th prosthetic valve. Since endocarditis was excluded by repeated blood culture and paucity of vegetations, a working diagnosis of Behcet's disease was arrived upon. The fifth prosthetic aortic valve was implanted using a special suturing technique as described by Azumo, et al in 2009, which involves a sub-annular reinforcement by a Teflon ring. The patient was discharged after an uneventful recovery and is well on regular follow-up.