Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve

Abstract

Acute prosthetic valve dysfunction due to leaflet escape is a mode of structural valve failure of mechanical prostheses which is associated with a high mortality. In this report, we describe the case of a 32-year-old patient, who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted to the hospital on August 2005, in cardiogenic shock. He discontinued oral anticoagulation therapy four months ago. Transthoracic and transesophageal echocardiograms showed acute-onset massive mitral regurgitation with normal left ventricular function. The patient underwent emergency surgery, during which one leaflet was found to be absent and the other leaflet was fixed due to prosthetic thrombus.

Spontaneous leaflet fracture resulting in embolization from mechanical valve prostheses

“…Following its introduction in 1979, by 2003 >600 cases were known to have valve fractures, often leading to sudden cardiac deaths . In addition to the BSCC valve, there are other valves that carry a higher risk for leaflet fracture and subsequent leaflet escape, of which the most prominent is the ED prosthesis (as illustrated by our case), followed by the TRI Technologies (TRI Technologies Prosthetic Heart Valve, Ltda, Belo Horizonte, Brazil) mechanical valve …”

“…Some clinics have offered prophylactic reoperations in asymptomatic patients to replace the TRI Technologies valve with excellent results. In one series, operative mortality was 0% in 22 patients and none of these patients experienced permanent complications . Nevertheless, in contrast to the large amount of data available for the BSCC cases, there is unfortunately no literature available in which large cohorts are analyzed and thoroughly examined for risk factors for leaflet fracture and escape in patients with ED or TRI Technologies valves.…”

“…1 In addition to the BSCC valve, there are other valves that carry a higher risk for leaflet fracture and subsequent leaflet escape, of which the most prominent is the ED prosthesis (as illustrated by our case), followed by the TRI Technologies (TRI Technologies Prosthetic Heart Valve, Ltda, Belo Horizonte, Brazil) mechanical valve. [2][3][4][5][6][7][8] The ED prosthesis (Baxter Healthcare Corp., Edwards Division) is a bileaflet mechanical heart valve first introduced and implanted in 1982. After approximately 20,000 valve prostheses were implanted the valve was withdrawn from the market in 1988 after at least 46 cases of leaflet escape were registered by the manufacturer.…”

“…37 Investigation into cases with valves other than the ED valve revealed significant tab malalignment and asymmetry in the TRI Tech valves in which tab fracture and leaflet escape had occurred. [3][4][5] Similar to the ED valve, valve analysis of fractured leaflets showed cavitation as the main contributing factor to valve failure and leaflet escape. 3-5…”

Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization

“…The leaflet escape from a prosthetic is one of the reasons for valve malfunctions. Leaflet escape due to fracture of a mechanical valve prosthesis has been previously reported for monoleaflet and bileaflet mechanical valves [Cianciulli 2007;Hemmer 2000;Bottio 2003]. It is very rare, is a critical condition for any patient, and is associated with cardiogenic instability and shock.…”