Late leaflet fracture and embolization of a Duromedics mitral prosthesis

Abstract

A case of leaflet fracture and embolization of a mitral prosthetic valve is described. A 54-year-old man had received mitral valve replacement with an Edwards-Duromedics 29M prosthetic valve, at 10 years ago. Emergency mitral valve replacement was performed because the patient had severe congestive left heart failure with severe acute mitral regurgitation caused by a fracture in one of the mitral valve leaflets. The leaflet, which was fractured into 2 pieces, was removed from the right common iliac artery at 3 months after valve replacement. Visual inspection revealed that the leaflet contained a midline fracture. The fracture originated within a cavitary erosion pit near the major radius of the leaflet. The patient recovered from acute renal failure, requiring hemodialysis for 80 days, and is currently without complaints. We have used a Duromedics mitral valve in 11 patients, from April 1987 to April 1988. No subsequent valve failure has occurred. The diagnosis, treatment and cause of a mechanical valve fracture are discussed.

Fracture Embolization of an Edwards-Duromedics Valve with Asymmetrical Closure

“…The most commonly reported location of the escaped leafl et is between the aorta and the femoral artery. [2][3][4][5][6][7] In this case, while one leafl et fragment was in the left common iliac artery, where it is usually found, the other fragment was located in the right brachiocephalic artery. Therefore, we removed the leafl et in the brachiocephalic artery under circulatory arrest during the same procedure.…”

“…The Edwards-Duromedics (ED) bileaflet prosthesis has been reported to yield good clinical results with low morbidity and functional improvement, nevertheless disc dislodgement and embolization have been reported to occur. 1 –5 The incidence of leaflet escapes was 0.029–0.08% per patient year and was higher in the mitral position than in the aortic position.…”

“…[1][2][3][4][5] The incidence of leafl et escapes was 0.029-0.08% per patient year and was higher in the mitral position than in the aortic position.…”

Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery

“…Interestingly, failures of mechanical valves in the past have always been related to high forces generated by the nonphysiologic closing mode. These include fracture of the outlet strut (Bjork-Shiley) by closing rebounds (30,31), leaflet erosion (Duromedic) by cavitation (32), thrombosis (Medtronic Parallel) (33,34) and closing leaflet dysfunction (Medtronic Advantage) as well as by design flaws (35). The forces observed during a mechanical bi-leaflet valve's closure are by far higher than those needed to close a tissue valve.…”

Spontaneous leaflet fracture resulting in embolization from mechanical valve prostheses

“…Twenty-one papers reporting 23 cases involving ED or Edwards TEKNA valves were published after discontinuation [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (Table 1). In these cases, fractured leaflets occured more commonly from mechanical mitral valves compared to aortic valves (87% vs 13%).…”