Introduction

A 61-year-old man underwent aortic valve replacement with a Sorin Solo 23 mm bioprosthetic valve due to severe aortic stenosis and multiple coronary artery bypass grafts due to obstructive coronary atherosclerosis. The past medical history reported surgical replacement of the right knee and coxo-femoral joint, dyslipidaemia and mild chronic renal failure. Transthoracic echocardiography documented severe aortic stenosis with a pressure gradient of 98/63 mm Hg and a calculated aortic valve area of 0.7 cm² (aortic valve area index 0.3 cm²/m²). Intraoperatively, the severely calcified aortic valve as well as the vessels showed extensive blue-black pigmentation. Grossly, the resected aortic valve cusps featured typical findings of senile degenerative dystrophic calcification, besides black pigmentation (figure 1A). Histological examination …