Wolf in Wolf's Clothing—A Case of Prosthetic Aortic Valve Thrombosis Presenting as an Acute Coronary Syndrome

Bridgman, John C; Chik, W.; Heddle, Bill

doi:10.1016/j.hlc.2006.02.005

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Mechanical valve leaflet dysfunction is most often due to pannus formation, thrombosis, or a combination of both. The reported incidence of mechanical aortic valve thrombosis is 0.2% per patient-year [Bridgman 2006]. Suture material obstructing the closure mechanism [Kidher 2009] and intermittent jamming of the mechanical valve leaflet in the absence of any apparent extrinsic cause [Russhard 2011] have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Blockage of a Mechanical Aortic Valve Leaflet with BioGlue: A Case Report

Gabrijelčič¹

2012

The Heart Surgery Forum

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Mechanical aortic valve dysfunction is a very rare event and is usually due to thrombosis, pannus overgrowth, or both. BioGlue as a cause for such a complication has been reported only occasionally. We describe a case of a 63-year-old woman who underwent operation for symptomatic tight aortic stenosis. After implantation of an aortic valve (AGN-751, size 19; St. Jude Medical, St. Paul, MN, USA) because of a transverse tear of the aortic wall above the annulus occurring during the suturing of the aortotomy, a triangular Vascutek Dacron patch (Vascutek/Terumo, Inchinnan, Scotland, UK) was included. To secure hemostasis, BioGlue (CryoLife, Kennesaw, GA, USA) was applied. A transthoracic echocardiography (TTE) examination performed after signs of ischemia appeared in the electrocardiogram on postoperative day 5 revealed an aortic transvalvular gradient of 74/38 mm Hg and a functional valve area of 1.0 cm2. No coronary lesions were revealed in a coronarography evaluation, but cinefluoroscopy (CF) examination revealed immobility of 1 valve leaflet. The reoperation revealed a thick, rough layer of the glue on the inner side of the patch. This glue had run down to the valve, blocking a mechanical leaflet. Cleaning the valve was not possible, and the valve had to be changed. The subsequent postoperative course was uneventful. The transvalvular gradient was 39/20 mm Hg, and the functional valve area was 1.2 cm2. We believe that the use of BioGlue and other surgical sealants is justified to secure complex suture lines and for maintaining hemostasis in cardiac surgery, but some precautionary rules must be respected. Authors have indicated that the glue enters through the needle holes in such cases, but our findings suggest it can also pass to the Dacron patch itself. CF is superior to TTE and transesophageal echocardiography for analyzing movement of the mechanical valve leaflet, and cardiac catheterization is rarely needed.

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Section: Discussionmentioning

confidence: 99%