Valvular allografts

If you have trouble filling-in this electronic form please contact the EHB (Tel. +32 (0)2 225.94.51 or 53). 

For emergencies (requests expected to be answered within 24h) or semi-emergencies (requests expected to be answered within 48h), please first fill-in the form, then call the EHB. 

The EHB contact line +32 (0)2 225.94.51 or 53 is operational 24h/day 7d/week. 

Thank you.

AV
mm
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cm
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AC
mm
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cm
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PV
mm
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cm
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PC (= PV with branches !)
mm
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cm
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MiV
mm
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cm
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Defective material
Underlying disease
Associated disease
Type of operation