Immobilization of Disc Heart Valves by Unraveled Sutures

Starek, Peter J.K.

doi:10.1016/s0003-4975(10)61320-3

Cited by 26 publications

(2 citation statements)

References 4 publications

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“…In case of the St. Jude Medical valve medial displacement of the pivot of the offended leaflet causes an additional increase of the leaflet/orifice gap and thus increased leakage. lt is apparent that the tendency of sutures to wedge between occluder and valve ring depends on occluder/ orifice clearance, freedom of lateral and vertical motion of the occluder in closed position, and diameter and compressibility of the suture (11). Our study indicates that a relatively incompressible suture like monofilament polypropylene (Prolene) causes higher friction forces than a braided suture (Ticron).…”

Section: Discussionmentioning

confidence: 74%

“…In order to avoid the possibility of migration of suture or chordal remnants between occluder and valve ring, suture ends should be cut short: the sutures should not be placed through the sewing skirt close to the valve ring; in case of using simple sutures, the ties should be knotted toward the tissue annulus: in case ofusing horizontal mattress sutures, the suture ends should be tied down with adjacent sutures (11); residual chordal tissue should be meticulously removed. Also, preservation of all or part ofthe native mitral apparatus, as suggested in mitral valve replacement in order to retain myocardial function, should not coincide with increase ofmechanical obstruction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Jamming of Prosthetic Heart Valves by Suture Trapping: Experimental Findings

Son¹,

Steinseifer²,

Reul³

et al. 1989

Thorac cardiovasc Surg

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The vulnerability of the Medtronic-Hall, Björk-Shiley Monostrut, Duromedics, and St. Jude Medical valves to occluder immobilization by sutures was determined under static and pulsatile flow conditions. Variables were cardiac output, cross-sectional diameter of suture, type of suture (braided versus monofilament) and position of the offending suture along the circumference of the valve ring. Under static conditions, pressures, ranging from 40 to 340 mmHg and 10 to 170 mmHg, were required to decompress obstructed Medtronic-Hall and Björk-Shiley Monostrut valves, respectively. As a result of different design characteristics and different occluder/orifice clearances the Medtronic-Hall valve showed its maximum opening pressure in case of interference with sutures at the axis of symmetry in both minor and major orifices, whereas for the Björk-Shiley Monostrut valve this was reached in the minor orifice. Under pulsatile flow conditions, in case of interference with Prolene 2-0 suture, the Duromedics valve showed irregularly delayed opening and an opening pressure difference of 50 mmHg at a cardiac output of 8 L/min, whereas leaflet motion and pressure difference in the St. Jude Medical valve were undisturbed under similar conditions. The necessary pressure difference for opening the Medtronic Hall valve reached 44mmHg at a cardiac output of 8 L/min. High and low risk of extrinsic leaflet obstruction in the Duromedics and St. Jude Medical valves, respectively, is related to the design of the hinge mechanisms and the wedge angle of their leaflets (2 degrees versus 25 degrees). Precautionary principles in implantation of prosthetic heart valves are stressed to prevent the potentially lethal complication of occluder immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%