Apicoaortic Double-Valved Conduit in a 40-Year-Old Woman

A 40-year-old woman was admitted with pneumonia andseptic shock. Chest x-ray showed bilateral pulmonary infiltrates, cardiomegaly, and a bioprosthetic valve in an unusual position near the left ventricular apex (Figure 1A). The patient had a history of muscular subaortic stenosis. At age 4, she underwent surgical resection, but severe subaortic stenosis recurred 5 years later when an apicoaortic conduit containing an Ionescu–Shiley bioprosthetic valve was placed between the left ventricular apex and the descending thoracic aorta. Six years later, a 22-mm St. Jude mechanical prosthesis was also inserted within the apicoaortic conduit, distal to the malfunctioning (regurgitant) Ionescu–Shiley prosthesis. Transesophageal echocardiography showed a patent con-duit containing a normally functioning St. Jude prosthesis, with no evidence of endocarditis (Figure 2). A cardiac computed tomography scan clearly showed the proximall