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A 74 year old man with Canadian Cardiovascular Society class II stable angina was referred to São Lucas Hospital, Porto Alegre, Brazil, for cardiac catheterisation in May 2003. He had a past medical history significant for aortic valve stenosis, having previously been treated in August 1965 with a Starr-Edwards metallic valve prosthesis; the surgery was performed at the University of Indiana Hospital, Indianapolis, USA.
Coronary angiography revealed a moderate proximal circumflex artery lesion. In the fluoroscopic evaluation, the caged ball prosthesis presented normal mobility and no signs of structural deterioration (panels A and B). Ascendant aortography showed a 5.5 cm aneurysm and mild aortic regurgitation. Transoesophageal echocardiography showed an ascendant aortic aneurysm, a well functioning aortic valve prosthesis with minimal regurgitation, and a turbulent systolic jet with a mean pressure gradient of 18 mm Hg. Left ventricular ejection fraction was estimated at 60%. The patient has been on anticoagulation since the surgery with no significant clinical complication. Since the coronary angiogram, the patient has been kept on medical treatment for coronary artery disease, and remains in stable condition.
The first case of aortic valve replacement with the Starr-Edwards metallic prosthesis was reported in 1965. This prosthesis was also used to replace the mitral valve. However, the mitral replacement with this prosthesis was abandoned because of thrombotic complications. In the aortic position, the Starr-Edwards metallic valve was widely used until the 1970s, when it started to be replaced by the tilting disc metallic valves. This case report demonstrates the impressive durability of the Starr-Edwards prosthesis in the aortic position.