We report an unusual case of early structural failure of the Freestyle stentless bioprosthesis 22 months after initial implantation. A 71-year-old woman, who had undergone stentless valve implantation by the subcoronary method, presented with a new diastolic murmur and progressive congestive heart failure 20 months after the initial implantation. Reoperation was performed using a stented bioprosthesis. The explanted prosthesis showed a tear along the annulus in one cusp. There were no findings of bacterial endocarditis or other macroscopical changes including calcification, thrombus attachment and pannus formation. It is believed that the cause of the cuspal tear was primary tissue failure. Further study is needed to clarify the incidence of this event.
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