Causes and treatment strategies of unilateral leaflet escape of bileaflet mechanical prosthetic heart valves after surgery: a case series

Abstract

Background During the eleven years from 2010 to 2021, preliminary statistics have shown that Fuwai Hospital completed 23,571 mechanical valve replacements for various types of valves, and 1139 mechanical valve replacements were performed in Guangyuan First People's Hospital. Only two patients developed valve leaflet escape, so valve leaflet escape is a rare postoperative complication. Case presentation In 2010 and 2021, two patients were selected after they had unilateral leaflet escape after having mechanical valve replacements in Fuwai Hospital of Chinese Academy of Medical Sciences and Guangyuan First People's Hospital. Both patients underwent reoperations with the classic operation and the new bileaflet mechanical prosthetic heart valve was sutured. The treatment of detached single lobe and distal vessel was comprehensively determined, and the condition was treated according to the patient's symptoms, CT results, ultrasound results and other test results, as well as whether this detached lobe caused any abnormal hemodynamics of the distal vessel. The patient with mechanical aortic valve escape completed the 10-year follow-up, and patient with mechanical mitral valve escape completed the 3-month follow-up. there was no thrombosis or hematoma at the embolic site; the patient had no lower limb symptoms. Conclusions The reason for the leaflet escape may be related to the valve design and the leaflet material. If the detached leaflets are damaged and if the distal blood vessels are affected, simultaneous surgical treatment is required. Those patients whose vessels were not damaged by the valve lobe should be carefully monitored.

Complete dislodgement of a mechanical valve prosthesis: A rare but potentially life-threatening event: a case report

“…Prosthetic valve complications, both early and late, encompass PPM, geometric mismatch, dehiscence, primary failure, thrombosis, thromboembolism, pannus formation, pseudoaneurysm formation, endocarditis, and hemolysis. [4] A study by Wang et al [2] reported that Fuwai Hospital and Guangyuan First People's Hospital conducted 24,710 valve replacements and 3264 first-time valve replacements over a decade. Among these cases, only 2 instances of unilateral leaflet escape were identified, constituting 0.06% of second-stage valve replacement cases.…”

“…[1] Since its introduction in 1980, the bileaflet mechanical prosthetic heart valve has emerged as the predominant product due to its exceptional performance. [2] Despite their increased durability compared to bioprostheses, mechanical prosthetic heart valves may encounter dysfunction attributed to 4 primary phenomena: thrombosis; fibrotic pannus ingrowth; degeneration; and endocarditis. [3] Although complete valve dislodgement remains unreported, the primary causative factor is likely the deterioration and breakage of sutures.…”

The Effect of Bileaflet Mechanical Heart Valve Designs on Biomechanical Behaviours – A Finite Element Analysis

“…The sewing ring is used to attach and fix the orifice ring to the heart tissue [14]. Three classifications of mechanical heart valve available which are caged-ball, single-tilting disk, and bileaflet-tilting disk valves [10,15]. The bileaflet valve is found to be the most common implanted mechanical valve that introduced to provide a better blood flow, low jet velocity, small pressure drops, and large effective orifice area [16].…”