{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:45:42Z","timestamp":1740185142427,"version":"3.37.3"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gen Thorac Cardiovasc Surg Cases"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Repeat surgery is common in adult congenital heart disease, and valve-related procedures are the most frequent indication for re-intervention. In these cases, problems such as advanced adhesion, deterioration and calcification of the prosthesis used, progression of cardiac dysfunction, and worsening of the general condition are often observed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We herein report a 43-year-old patient with repaired pulmonary atresia and ventricular septal defect who experienced repeated right heart failure and protein-losing enteropathy after multiple bioprosthetic tricuspid and pulmonary valve replacements. The patient was successfully treated with a fourth pulmonary valve replacement and third tricuspid valve replacement using a mechanical valve. During surgery, peeling off and removing the right ventricular outflow conduit was risky due to dense adhesion to the ascending aorta with extremely severe calcification; thus, the mechanical pulmonary valve was implanted to a more proximal position of the right ventricular outflow tract after removing the leaflet only and leaving the stent of the bioprosthetic valve within the conduit. The right heart failure and protein-losing enteropathy were relieved with this surgery, and the patient has remained in remission for over 5\u00a0years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Although severe adhesion and porcelain-like calcification caused by multiple surgical interventions were a major issue in this case, good surgical results were obtained. This method has a major advantage over conventional pulmonary valve replacement with right ventricle outflow tract reconstruction when the right ventricular outflow tract conduit shows severe adhesion and calcification.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s44215-024-00126-w","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T12:03:08Z","timestamp":1705060988000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary valve replacement for porcelain right ventricular outflow tract following repeated surgical intervention"],"prefix":"10.1186","volume":"3","author":[{"given":"Satoshi","family":"Fujita","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Tatewaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ichiro","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihisa","family":"Tanoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0865-0169","authenticated-orcid":false,"given":"Akira","family":"Shiose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"key":"126_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jacc.2005.02.083","volume":"46","author":"CA Warnes","year":"2005","unstructured":"Warnes CA. The adult with congenital heart disease: born to be bad? J Am Coll Cardiol. 2005;46:1\u20138.","journal-title":"J Am Coll Cardiol"},{"key":"126_CR2","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.athoracsur.2011.03.102","volume":"92","author":"KA Holst","year":"2011","unstructured":"Holst KA, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Li Z, et al. Risk factors and early outcomes of multiple reoperations on adults with congenital heart disease. Ann Thorac Surg. 2011;92:122\u201330.","journal-title":"Ann Thorac Surg"},{"key":"126_CR3","doi-asserted-by":"publisher","first-page":"e537","DOI":"10.1016\/j.athoracsur.2020.03.130","volume":"110","author":"H Tatewaki","year":"2020","unstructured":"Tatewaki H, Sakamoto I, Ushijima T, Shiose A. Pulmonary valve replacement via left thoracotomy as an alternative to resternotomy. Ann Thorac Surg. 2020;110:e537\u20139.","journal-title":"Ann Thorac Surg"},{"key":"126_CR4","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1053\/j.pcsu.2015.12.003","volume":"19","author":"JM Stulak","year":"2016","unstructured":"Stulak JM, Mora BN, Said SM, Schaff HV, Dearani JA. Mechanical pulmonary valve replacement. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2016;19:82\u20139.","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"key":"126_CR5","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s11748-018-1012-0","volume":"67","author":"MG Dehaki","year":"2019","unstructured":"Dehaki MG, Al-Dairy A, Rezaei Y, Omrani G, Jalali AH, Javadikasgari H, et al. Mid-term outcomes of mechanical pulmonary valve replacement: a single-institutional experience of 396 patients. Gen Thorac Cardiovasc Surg. 2019;67:289\u201396.","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"126_CR6","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1016\/j.athoracsur.2020.02.040","volume":"110","author":"Y Kang","year":"2020","unstructured":"Kang Y, Hwang HY, Sohn SH, Choi JW, Kim KH, Kim KB. Fifteen-year outcomes after bioprosthetic and mechanical tricuspid valve replacement. Ann Thorac Surg. 2020;110:1564\u201371.","journal-title":"Ann Thorac Surg"},{"key":"126_CR7","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jacc.2014.04.025","volume":"64","author":"AS John","year":"2014","unstructured":"John AS, Johnson JA, Khan M, Driscoll DJ, Warnes CA, Cetta F. Clinical outcomes and improved survival in patients with protein-losing enteropathy after the Fontan operation. J Am Coll Cardiol. 2014;64:54\u201362.","journal-title":"J Am Coll Cardiol"},{"key":"126_CR8","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1007\/s00246-018-1893-9","volume":"39","author":"S Ono","year":"2018","unstructured":"Ono S, Ohuchi H, Miyazaki A, Yamada O. Comparison of clinical profiles in patients with protein-losing enteropathy with and without Fontan circulation. Pediatr Cardiol. 2018;39:1290\u20138.","journal-title":"Pediatr Cardiol"}],"container-title":["General Thoracic and Cardiovascular Surgery Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-024-00126-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44215-024-00126-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-024-00126-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T12:05:30Z","timestamp":1705061130000},"score":1,"resource":{"primary":{"URL":"https:\/\/gtcscases.biomedcentral.com\/articles\/10.1186\/s44215-024-00126-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,12]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["126"],"URL":"https:\/\/doi.org\/10.1186\/s44215-024-00126-w","relation":{},"ISSN":["2731-6203"],"issn-type":[{"type":"electronic","value":"2731-6203"}],"subject":[],"published":{"date-parts":[[2024,1,12]]},"assertion":[{"value":"8 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"With regard to the collection of clinical data, the need for patient consent was waved.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient to publish this case report and associated images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1"}}