Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve (original) (raw)
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Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve
European Journal of Echocardiography, 2006
The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation.To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.
Prosthetic Mitral Valve Leaflet Escape
Journal of Cardiovascular Ultrasound, 2013
Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well.
Intraoperative detection of stuck leaflet of prosthetic mitral valve
Indian Heart Journal, 2017
Bileaflet prosthesis valves are the most commonly used mechanical valves. Dysfunction of bileaflet prosthesis valve is rarely observed. Pannus and thrombus can obstruct prosthesis valve in postoperative period over a period of time. Here we present a rare case of intraoperatively diagnosed prosthesis valve dysfunction along with review of different mechanism causing such complication. 50 years male presented with severe shortness of breath at rest and fever since 15 days. He was already on antibiotics when he was referred to our center for further management.He was thoroughly evaluated and echocardiography showed severe mitral regurgitation with vegetation on posterior mitral leaflet bouncing in left atrium. Considering high embolic potential of the lesion, patient was urgently scheduled for open heart surgery for removal of lesion and correction of mitral regurgitation. After smooth anaesthesia induction, transesophageal echocardiography (TEE) was performed and it revealed 1.2 square cm mobile mass on the posterior mitral leaflet. (Fig. 1, clip 1) Severe mitral regurgitation was observed due to noncoaptation of mitral leaflets. (Fig. 2, clip 2) After instituting cardiopulmonary bypass, mass with mitral leaflets were resected and sent for bacterial and fungal cultures. OnX 25 mm bileaflet prosthetic mechanical mitral valve was inserted. While weaning from bypass, TEE revealed one stuck leaflet of prosthetic mitral valve in semiclosed position, where as other leaflet was moving normally.
We present five cases of mitral bileaflet prosthesis dysfunction as a result of a stuck leaflet in closed position, diagnosed at surgery or during the first postoperative year. Methods and results: The diagnosis was made by echocardiography and could be confirmed by fluoroscopy in three patients. All cases had in common an early occurrence and the presence of a clean prosthesis by transesophageal echocardiography (TEE). In one patient the diagnosis was made by intraoperative TEE, and the problem could be solved by rotation of the occluding device. In the other four patients the diagnosis was made postoperatively and different strategies of treatment were taken. All but one case were reoperations, one had a dysfunctional biological prosthesis and three had been submitted to mitral valvoplasty (two rheumatic and one degenerative valves). According to our policy, patients started sodium warfarin therapy 24 h after surgery in order to keep International normalized ratio (INR) values between 2.5-3.5. Only in one case the presence of thrombusypannus could be confirmed. Conclusions: We call the attention to causes other than thrombosis that can provoke leaflet block and to the importance of performing intraoperative TEE in patients submitted to mitral valve replacement. We also emphasize the fact that a stuck leaflet in a clean prosthesis can evolve without major symptoms or cardiac events.
Cureus
Early bioprosthetic mitral valve failure is uncommon, but cases can present with symptomatic heart failure and require careful attention and evaluation. Transcatheter valve replacement is a minimally invasive treatment for mitral valve dysfunction that can have a considerable impact, particularly for those who are at high surgical risk or have a history of bioprosthetic valve failure. We present a rare case of significant mitral regurgitation due to the unexpected premature failure of a bioprosthetic valve that was implanted three years prior. This patient was treated with transcatheter mitral valve replacement with the implantation of an Edwards SAPIEN Ultra (Edwards Lifesciences) valve.
Leaflet Escape in a New Bileaflet Mechanical Valve: TRI Technologies
Circulation, 2003
Background-Leaflet escape is a mode of structural valve failure for mechanical prostheses. This complication previously has been reported for both monoleaflet and bileaflet valve models. We report 2 leaflet escape occurrences observed in 2 patients who underwent valve replacement with a TRI Technologies valve prosthesis. Methods and Results-At the University of Padua, between November 2000 and February 2002, 36 TRI Technologies valve prostheses (26 aortic and 10 mitral) were implanted in 34 patients (12 women and 22 men) with a mean age of 59.9Ϯ10.3 years (range, 30 to 75 years). There were 5 deaths: 3 in hospital, 1 early after discharge, and 1 late. Two patients experienced a catastrophic prosthetic leaflet escape; the first patient was a 52-year-old man who died 10 days after aortic valve and ascending aorta replacement, and the second was a 58-year-old man who underwent a successful emergency reoperation 20 months after mitral valve replacement. Examination of the explanted prostheses showed in both cases a leaflet escape caused by a leaflet's pivoting system fracture. Prophylactic replacement was then successfully accomplished so far in 12 patients, without evidence of structural valve failure in any of them. Among other significant postoperative complications, we observed 3 major thromboembolisms, 1 hemorrhage, and 1 paravalvular leak. Conclusion-These catastrophes prompted us to interrupt the implantation program, and they cast a shadow on the durability of the TRI Technologies valve prosthesis because of its high risk of structural failure.
Survival After Mitral Valve Replacement for Leaflet Escape in a Contemporary On-X Mechanical Valve
The Annals of Thoracic Surgery, 2019
Leaflet escape in contemporary mechanical valves is an extremely rare and potentially lethal condition. We report the case of a 77-year-old male who presented with embolization of a leaflet from an On-X Mitral Valve with Conform-X Sewing Ring prosthesis after exercise. The patient recovered completely 6 months after surgery and is currently asymptomatic.
Acute dysfunction from thrombosis of a mechanical mitral valve prosthesis]]>
Brazilian Journal of Cardiovascular Surgery, 2005
An 64-year-old man received a 31-mm CarboMedics mechanical prosthesis for severe mitral regurgitation. After four days the patient presented fatigue and dyspnoea with rest; transthoracic and transesophageal Doppler echocardiographic study confirmed a failing mobility of prosthetic valve leaflet from thrombosis and an emergency operation was done. The postoperative course was uneventful. This is an unusual case of acute dysfunction from thrombosis of a mechanical mitral valve prosthesis in a patient on oral anticoagulant therapy and calciheparin. Descriptors: Thrombosis. Echocardiography. Mitral valve replacement Resumo Um homem de 64 anos recebeu uma prótese mecânica CarboMedics de 31 mm para refluxo mitral grave. Após quatro dias, o paciente apresentou-se com fadiga e dispnéia em repouso. Estudos do Doppler ecocardiografia transtorácica e transesofágica confirmaram uma disfunção na mobilidade do folheto da válvula protética devido à trombose e uma operação de emergência foi feita. O pós-operatório transcorreu sem intercorrências. Este é um caso incomum de disfunção grave devido à trombose de uma prótese mitral mecânica em um paciente tomando anticoagulantes orais e calciparina. Descritores: Trombose. Ecocardiografia. Troca da válvula mitral Disfunção aguda devido a uma trombose da prótese da válvula mitral mecânica Acute dysfunction from thrombosis of a mechanical mitral valve prosthesis
Occasional Single Beat Regurgitation Observed with the Medtronic Advantage Bileaflet Heart Valve
The Annals of Thoracic Surgery, 2006
Background. The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institution, 63 patients received the Advantage bileaflet mechanical heart valve (Medtronic, Minneapolis, Minnesota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients.