Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization
AbstractBackground: Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models.
Methods: A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn’t specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the 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 during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy.
Results: After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery.
Conclusion: The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.
Alvarez J, Deal CW. 1990. Leaflet escape from a Duromedics valve. J Thorac Cardiovasc Surg 99:372.
Baudet E, Roques X, McBride J, Panès F, Grimaud JP. 1995. A 8-year follow-up of the Edwards-Duromedics bileaflet prosthesis. J Cardiovasc Surg (Torino) 36:437-42.
Borowski A, Reib N, Klaer R. 1992. Intermittent obstruction of the Omnicarbon-valve prosthesis in the mitral position due to interference by papillary muscle. J Cardiovasc Surg 33:305-7.
Bottio T, Casarotto D, Thiene G, Caprili L, Angelini A, Gerosa G. 2003. Leaflet escape in a new bileaflet mechanical valve: TRI technologies. Circulation 107:2303-6.
Cianciulli TF, Lax JA, Saccheri MC, et al. 2007. Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve. Eur J Echocardiogr 8:63-6.
Deuvaert FE, Devriendt J, Massaut J, Van Nooten G, De Paepe J, Primo G. 1989. Leaflet escape of a mitral Duromedics prosthesis. Case report. Acta Chir Belg 89:15-18.
Devbhandari MP, Woo EB, Hooper TL. 2008. Long-term event-free survival with an embolised prosthetic valve leaflet in the thoracic aorta. J Cardiothorac Surg 3:34.
Dikmengil M, Sucu N, Aytacoglu BN, Mavioglu I. 2004. Leaflet escape in a TRI bileaflet rotatable mitral valve. J Heart Valve Dis 13:638-40.
Fragoulis S, Palatianos GM. 2008. Fractured prosthetic valve leaflet. Eur J Cardiothorac Surg 34:907.
Hemmer WB, Doss M, Hannekum A, Kapfer X. 2000. Leaflet escape in a Tekna and an original Duromedics bileaflet valve. Ann Thorac Surg 69:942-4.
Jazayeri S, Meunier JP, Tatou E, et al. 2001. Fracture embolization of a Tekna mitral prosthesis: Case report. J Heart Valve Dis 10:219-21.
Kim JH, Oh SS, Na CY, Baek MJ, Seo HJ, Kim CW. 2004. Leaflet escape of edwards duromedics mechanical heart valve: report of 1 case. Korean J Thorac Cardiovasc Surg 37:373-5.
Klepetko W, Moritz A, Mlczoch J, Schurawitzki H, Domanig E, Wolner E. 1989. Leaflet fracture in Edwards-Duromedics bileaflet valves. J Thorac Cardiovasc Surg 97:90-4.
Kornberg A, Stephen MW, Schulze C, Kreuzer E. 1999. Leaflet escape in Omnicarbon monoleaflet valve. Eur J of Cardiothorac Surg 15:867-9.
Kumar N, Balasundaram S, Rickard M, al Halees Z, Duran CM. 1991. Leaflet embolisation from Duromedics valves: a report of two cases. Thorac Cardiovasc Surg 39:382-3.
Lee SY, Choi JB. 2007. Escape of mechanical valve: a case report. Korean J Thorac Cardiovasc Surg 40:63-5.
Messner-Pellenc P, Wittenberg O, Leclercq F, et al. 1993. Doppler echocardiographic evaluation of the Omnicarbon cardiac valve prostheses. J Cardiovasc Surg 34:195-202.
Tatou E, Saleh M, Eicher C, Brenot R, David M. 2001. Fracture-embolization of duromedics valve prosthesis and microscopic uncommon lesions. Ann Thorac Surg 71:1366-9.
Vogel W, Stoll HP, Bay W, Fröhlig G, Schieffer H. 1993. Cineradiography for determination of normal and abnormal function in mechanical heart valves. Am J Cardiol 71:225-32.
Youn YN, Yoo KJ. 2002. Valve leaflet escape of edwards duromedics mechanical valve. Korean J Thorac Cardiovasc Surg 35:60-3.
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