{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T13:29:14Z","timestamp":1740144554495,"version":"3.37.3"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Perpendicular transvalvular leakage (TVL) is occasionally observed after aortic valve replacement (AVR) in biological valves with a stent post, often originating from the base of the stent post. However, an observed perpendicular jet flow is not always a TVL. In rare cases, paravalvular leakages (PVLs) can be perpendicular and are present behind a TVL. In the present case, both PVL and TVL existed simultaneously as unusual perpendicular jet flows that originated from sites in close proximity to the stent post.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 73-year-old man underwent AVR with a biological valve in the supra-annular position using the non-everting mattress suture technique with pledgets. After weaning from cardiopulmonary bypass (CPB), transesophageal echocardiography (TEE) revealed an unfamiliar perpendicular turbulent flow, similar to reported TVL, originating from the anterior stent post. Further TEE examination revealed a PVL had originated from the site between the sewing ring at the anterior stent post and native annulus attached to a pledget. The space between the sewing ring and annular retained native portion caused the perpendicular turbulent jet. Consequently, two types of perpendicular turbulent flows, TVL and PVL, existed adjacent to each other.<\/jats:p>\n                <jats:p>After reinstitution of CPB, inspection of the prosthesis itself indicated it to be normal, but there was a region adjacent to the anterior stent post near the right coronary ostium where the tip of the curved Pean forceps entered between the sewing ring and the native annulus. The region was consistent with TEE findings. AVR was performed with the same prosthesis again. After weaning from CPB, immediate TEE revealed that the unusual perpendicular turbulent flows had disappeared and only a few small TVLs were observed. Regarding the disappearance of TVL, we considered that the fabric region of the prosthetic valve was covered with cellular elements to prevent the leak, as it was already used in AVR once and soaked in blood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Perpendicular turbulent flow raises the possibility of both TVL and PVL in the case of AVR with stented bovine pericardial valves. For a differential diagnosis of TVL or PVL, it is important to know the surgical procedures and valve morphology.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13019-020-1050-4","type":"journal-article","created":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T17:03:12Z","timestamp":1579021392000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perpendicular and turbulent flow after aortic valve replacement: paravalvular or transvalvular leakage? \u2013 a case report"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4834-0405","authenticated-orcid":false,"given":"Shihoko","family":"Iwata","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiaki","family":"Inano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Ozaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,1,14]]},"reference":[{"key":"1050_CR1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/1476-7120-8-52","volume":"8","author":"M Kuroda","year":"2010","unstructured":"Kuroda M, Sudo T, Koizuka S, Nishikawa K, Kadoi Y, Saito S. Regurgitant leak from the area between the stent post and the sewing ring of a stented bovine pericardial valve implanted in the aortic valve position. Cardiovasc Ultrasound. 2010;8:52.","journal-title":"Cardiovasc Ultrasound"},{"key":"1050_CR2","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00540-009-0821-9","volume":"23","author":"T Kunisawa","year":"2009","unstructured":"Kunisawa T, Sasakawa T, Kishi M, Suzuki A, Takahata O, Iwasaki H. Transvalvular leakage after the implantation of stented bovine pericardial valves is not only central. J Anesth. 2009;23:639\u201340.","journal-title":"J Anesth"},{"key":"1050_CR3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/S0735-1097(01)01361-4","volume":"38","author":"DJ O\u2019Rourke","year":"2001","unstructured":"O\u2019Rourke DJ, Palac RT, Malenka DJ, Marrin CA, Arbuckle BE, Plehn JF. Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography. 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Eur J Cardiothorac Surg. 2012;42:486\u201392.","journal-title":"Eur J Cardiothorac Surg"},{"key":"1050_CR6","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1053\/j.jvca.2013.06.007","volume":"28","author":"CA Weber","year":"2014","unstructured":"Weber CA, Prasad R, von Ballmoos MW, Nicolosi AC, Pagel PS. New regurgitation after aortic valve replacement with a stented bovine pericardial prosthesis: is the leak paravalvular or non-paravalvular? J Cardiothorac Vasc Anesth. 2014;28:857\u20139.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"1050_CR7","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/ehjci\/jew025","volume":"17","author":"P Lancellotti","year":"2016","unstructured":"Lancellotti P, Pibarot P, Chambers J, Edvardsen T, Delgado V, Dulgheru R, et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:589\u201390.","journal-title":"Eur Heart J Cardiovasc Imaging"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-020-1050-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13019-020-1050-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-020-1050-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T00:18:38Z","timestamp":1610497118000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-020-1050-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,14]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1050"],"URL":"https:\/\/doi.org\/10.1186\/s13019-020-1050-4","relation":{},"ISSN":["1749-8090"],"issn-type":[{"type":"electronic","value":"1749-8090"}],"subject":[],"published":{"date-parts":[[2020,1,14]]},"assertion":[{"value":"17 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This case report was approved by the institutional review board (approval number: 4989)<b>.<\/b>","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of the clinical details was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19"}}