Blockage of a Mechanical Aortic Valve Leaflet with BioGlue: A Case Report

Authors

  • Tone Gabrijelcic

DOI:

https://doi.org/10.1532/HSF98.20121067

Abstract

Mechanical aortic valve dysfunction is a very rare event and is usually due to thrombosis, pannus overgrowth, or both. BioGlue as a cause for such a complication has been reported only occasionally. We describe a case of a 63-year-old woman who underwent operation for symptomatic tight aortic stenosis. After implantation of an aortic valve (AGN-751, size 19; St. Jude Medical, St. Paul, MN, USA) because of a transverse tear of the aortic wall above the annulus occurring during the suturing of the aortotomy, a triangular Vascutek Dacron patch (Vascutek/Terumo, Inchinnan, Scotland, UK) was included. To secure hemostasis, BioGlue (CryoLife, Kennesaw, GA, USA) was applied. A transthoracic echocardiography (TTE) examination performed after signs of ischemia appeared in the electrocardiogram on postoperative day 5 revealed an aortic transvalvular gradient of 74/38 mm Hg and a functional valve area of 1.0 cm2. No coronary lesions were revealed in a coronarography evaluation, but cinefluoroscopy (CF) examination revealed immobility of 1 valve leaflet. The reoperation revealed a thick, rough layer of the glue on the inner side of the patch. This glue had run down to the valve, blocking a mechanical leaflet. Cleaning the valve was not possible, and the valve had to be changed. The subsequent postoperative course was uneventful. The transvalvular gradient was 39/20 mm Hg, and the functional valve area was 1.2 cm2. We believe that the use of BioGlue and other surgical sealants is justified to secure complex suture lines and for maintaining hemostasis in cardiac surgery, but some precautionary rules must be respected. Authors have indicated that the glue enters through the needle holes in such cases, but our findings suggest it can also pass to the Dacron patch itself. CF is superior to TTE and transesophageal echocardiography for analyzing movement of the mechanical valve leaflet, and cardiac catheterization is rarely needed.

References

Barbetseas J, Zoghbi WA. 1998. Evaluation of prosthetic valve function and associated complications. Cardiol Clin 16:505-30.nBridgman JC, Chile W, Heddle W. 2006. Wolf in wolf's clothing—a case of prosthetic aortic valve thrombosis presenting as an acute coronary syndrome. Heart Lung Circ 15:334-6.nChhatriwalla AK, Lever HM, Pettersson G, Kapadia S. 2009. Role of invasive evaluation with cineradiography and intracardiac echocardiography to detect mechanical prosthetic valve dysfunction. J Invasive Cardiol 21:190-2.nGoldberg SP, Campbell DN. 2009. Mechanical aortic valve dysfunction due to biological glue. Ann Thorac Surg 88:671-2.nJelinek P, Vacha M, Sulda M. 2005. Images in cardiology: transoesophageal echocardiography showing a thrombosis of the aortic valve mechanical replacement before and after thrombolytic treatment. Heart 91:1351.nKarimi M, Kerber RE, Everett JE. 2005. Mechanical aortic valve malfunction: an intraoperative BioGlue complication. J Thorac Cardiovasc Surg 129:1442-3.nKaya EB, Kocabas U, Aytemir K, Tokgözoglu L. 2008. Successful fibrinolytic treatment in an old patient with acute aortic prosthetic thrombosis. Eur J Echocardiogr 9:581-3.nKhouzam RM. 2007. Cinefluoroscopy as the gold standard for mechanical valve mobility. Can J Cardiol 23:998.nKidher ES, Perera R, Rao C, Rehman SM, Sutaria N, Athanasiou T. 2009. A rare case of suture material obstructing the closure mechanism of a prosthetic aortic valve: a case report. Cases J 2:9126.nLeMaire SA, Carter SA, Won T, Wang X, Conklin LD, Coselli JS. 2005. The threat of adhesive embolization: BioGlue leaks through needle holes in aortic tissue and prosthetic grafts. Ann Thorac Surg 80:106-11.nMontorsi P, De Bernardi F, Muratori M, Cavoretto D, Pepi M. 2000. Role of cinefluoroscopy, transthoracic, and transesophageal echocardiography in patients with suspected prosthetic heart valve thrombosis. Am J Cardiol 85:58-64.nRusshard P, Weerasinghe A. 2011. Intermittent jamming of a bileaflet mechanical heart valve in the absence of an extrinsic cause of obstruction. Eur J Echocardiogr 12:E19.nShapira Y, Raanani E, Sagie A. 2006. "BioGlue" as a possible cause of acute blocked mechanical mitral valve leaflet. J Cardiovasc Surg (Torino) 47:581-3.nvon Mallek D, Heinz BC, Löffler BG, Mellert E 2008. Incidents of malfunction of mechanical heart valves as reported to the German Medical Devices Vigilance System [in German]. Dtsch Med Wochenschr 133:2008-13.n

Published

2012-12-21

How to Cite

Gabrijelcic, T. (2012). Blockage of a Mechanical Aortic Valve Leaflet with BioGlue: A Case Report. The Heart Surgery Forum, 15(6), E310-E312. https://doi.org/10.1532/HSF98.20121067

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Articles