Acute LVOT Obstruction with a Carbomedics Mechanical Valve Prosthesis

Abstract

A 62-year-old female with severe symptomatic rheumatic mitral stenosis was referred for mitral valve replacement. A 27-mm Carbomedics mechanical mitral valve was placed using everting sutures. As the patient was weaned off cardiopulmonary bypass, she became hemodynamically unstable. Intraoperative transesophageal echocardiogram revealed a significant drop in left ventricular function along with severe LVOT obstruction. The Carbomedics prosthesis was replaced by a 27-mm St. Jude mechanical valve using noneverting sutures which relieved the LVOT obstruction. doi: 10.1111/jocs.12749 (J Card Surg 2016;31:376-379).

Case Report: Using Medtronic AP360 mechanical prosthesis in mitral valve replacement for patients with mitral insufficiency after primum atrial septal defect repair to reduce left ventricular outflow tract obstruction risk

“…Similarly, the Mayo Clinic had reported a case of acute LVOTO after Carbomedics MVR (9), and they used a noneverting suture to solve this problem, which coincided with us on this point. Actually, LVOTO was more common in patients who had to have their MVR re-done.…”

A novel case of late left ventricular outflow tract obstruction post mitral valve surgery

“…A substantial proportion of the reported literature regarding LVOTO being caused by the prosthesis relates to the struts of bio-prosthetic valves encroaching into the LVOT. Additionally, there were many cases of fibrous material narrowing the LVOT [3].…”

“…2, the Carbomedics valve is protruding significantly into the LVOT. Severe LVOTO has previously been reported with a Carbomedics mitral valve which was subsequently relieved by replacing the prosthesis with a St. Jude valve [3].…”

The Value of Echocardiography in Unexpected Valve Disease in a Patient With Ischemic Cardiomyopathy: Less Is Not Always the Right Answer

“…LVOT obstruction by a mitral prosthesis is a recognized complication after cardiac surgery. 7,8 Typically, these occur after implantation of high-profile bioprosthetic valves and are due to strut malposition in the LVOT, but also can be due to malposition of a prosthetic valve. 17 In addition to maintaining a high index of suspicion, TEE plays a pivotal role in diagnosing the complication.…”

“…Post-CPB TEE revealed well-seated prostheses (Video 7) with acceptable mean gradients, no evidence of paravalvular leak, and slightly improved ventricular function on inotropic support. Given the patient's hemodynamics, the possibility of LVOT obstruction by the mitral valve prosthesis 7,8 was suggested to rule this out. 3D imaging of the left ventricle was used to confirm that the prosthesis struts in the mitral position were not obstructing the LVOT (Video 8).…”