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Concomitant pulmonary valve replacement, VSD closure and coronary artery bypass surgery.

BACKGROUND AND AIMS OF THE STUDY
Although pulmonary valve stenosis may be treated by percutaneous balloon valvulotomy, surgery is preferred in adult patients with dysplastic valves.


METHODS
Recently a 50-year-old man with isolated, calcific pulmonary stenosis and concomitant coronary artery disease was referred for surgery. Preoperatively, he suffered from dyspnea (NYHA class I-II) and angina pectoris (CCS class I-II). During catheterization a peak-to-peak gradient of 120 mmHg was measured across the pulmonary valve, while angiography revealed two-vessel coronary artery disease.


RESULTS
During surgery, after opening the main pulmonary artery, an unsuspected small ventricular septal defect (VSD) and a severely calcified, altered pulmonary valve were detected. The VSD was closed and the valve replaced with a stentless bioprosthesis; concomitant double coronary artery bypass grafting was performed. The postoperative course was uneventful.


CONCLUSIONS
Adult patients with pulmonary valve stenosis and concomitant coronary artery disease can be treated simultaneously by surgery with excellent results. Replacement devices may be homografts, or as in this patient, a stentless xenograft.