Leaflet Fracture of a St. Jude Mechanical Bileaflet Valve
2005; Lippincott Williams & Wilkins; Volume: 111; Issue: 18 Linguagem: Inglês
10.1161/01.cir.0000164200.94488.80
ISSN1524-4539
AutoresArend Mosterd, Ghada Shahin, Wim Jan van Boven, W. Jaarsma, Antonie D Graafland, H.A. van Swieten,
Tópico(s)Cardiac Structural Anomalies and Repair
ResumoHomeCirculationVol. 111, No. 18Leaflet Fracture of a St. Jude Mechanical Bileaflet Valve Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBLeaflet Fracture of a St. Jude Mechanical Bileaflet Valve A. Mosterd, G.M.M. Shahin, W.J. van Boven, W. Jaarsma, A.D. Graafland and H.A. van Swieten A. MosterdA. Mosterd From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. , G.M.M. ShahinG.M.M. Shahin From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. , W.J. van BovenW.J. van Boven From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. , W. JaarsmaW. Jaarsma From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. , A.D. GraaflandA.D. Graafland From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. and H.A. van SwietenH.A. van Swieten From the Meander Medical Center, Department of Cardiology, Amersfoort (A.M., A.D.G.), and the Heart Lung Center Utrecht, Departments of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein (G.M.M.S., W.J.v.B., W.J., H.A.v.S.), the Netherlands. Dr Shahin is currently at the Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands. Originally published10 May 2005https://doi.org/10.1161/01.CIR.0000164200.94488.80Circulation. 2005;111:e280–e281Eighteen months after mitral (33-mm St. Jude Medical) and aortic (25-mm Carbomedics Tophat) valve replacement because of rheumatic valve disease, a 54-year-old man was admitted with acute pulmonary edema. He had been in excellent condition until the sudden onset of epigastric pain and shortness of breath 2 hours before admission. Other than warfarin (International Normalized Ratio 2.7, 9 days before admission), he was not using any medication. Physical examination demonstrated a man in severe respiratory distress (blood pressure 95/60 mm Hg, temperature 36.2°C), and bilateral rales were heard. Heart sounds could not be detected. The ECG demonstrated sinus tachycardia (100/min) without signs of ischemia. The chest x-ray film showed bilateral pulmonary edema. After intubation and mechanical ventilation, a transesophageal echocardiogram was performed (Figure 1), revealing massive mitral regurgitation attributed to malfunctioning of one leaflet (Movies I, II, and III). The left ventricle was hyperdynamic. The patient was urgently transported to a thorax center (St. Antonius Hospital, Nieuwegein, the Netherlands). Although leaflet fracture was considered, mechanical valve thrombosis was considered more likely and thrombolytic therapy was initiated. On emergency surgery, which was performed because of progressive clinical deterioration, one leaflet of the mitral valve prosthesis was found to be broken, the major part missing (Figure 2). The valve was explanted and replaced by a 29-mm Carbomedics prosthesis. CT scanning localized the missing valve fragment in the right iliac artery bifurcation (Figure 3). This fragment was surgically removed 4 weeks later by a retroperitoneal approach. The patient made an uneventful recovery and returned to his professional life. Download figureDownload PowerPointFigure 1. Transesophageal echocardiographic still-frame image showing partial absence (A) of one leaflet. A indicates partial absence of one leaflet; L, leaflet in place; LAA, left atrial appendage.Download figureDownload PowerPointFigure 2. Explanted mitral valve prosthesis (A) and broken leaflet (B) recovered from right iliac artery.Download figureDownload PowerPointFigure 3. Axial CT image of pelvis, showing escaped leaflet fragment in right iliac artery (arrow). L5 indicates L5 vertebral body; P, psoas muscle; A, iliac artery; and V, Iliac vein.Movies I, II, and III are available in the online-only Data Supplement with this article at http://www.circulationaha.org.FootnotesCorrespondence to Dr A. Mosterd, Meander Medical Center, Department of Cardiology, PO Box 1802, 3800 BM Amersfoort, The Netherlands. E-mail [email protected] eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Papadakis E, Martens T and Kanakis M (2022) Spontaneous Prosthesis Leaflet Detachment and Loss During Aortic Valve Implantation, Journal of Cardiovascular Imaging, 10.4250/jcvi.2021.0131, 30:2, (140), . Al Mosa A, Drullinsky D, de Varennes B and Samoukovic G (2020) Spontaneous Leaflet Fracture of a St Jude Mechanical Mitral Bileaflet Prosthesis, Circulation: Cardiovascular Imaging, 13:11, Online publication date: 1-Nov-2020. Torres J, Arevalo A, Sastre J, González-Porras J, Salvador R, González-Santos J and Lozano F Spontaneous rupture of a mechanical valve in a mitral position (On-X) with migration-embolization to aortic bifurcation from the perspective of the vascular surgeon, The Journal of Cardiovascular Surgery, 10.23736/S0021-9509.20.11026-7, 61:2 van Steenbergen G, Tsang Q, van der Heide S, Verkroost M, Li W and Morshuis W (2018) Spontaneous leaflet fracture resulting in embolization from mechanical valve prostheses, Journal of Cardiac Surgery, 10.1111/jocs.13975, 34:3, (124-130), Online publication date: 1-Mar-2019. Ashraf O and Yadav S (2014) Bioprosthetic aortic valve replacement on a mechanical valve ring, Asian Cardiovascular and Thoracic Annals, 10.1177/0218492314531139, 23:9, (1060-1061), Online publication date: 1-Nov-2015. 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Eichinger W, Hettich I, Bleiziffer S, Günzinger R, Hutter A, Bauernschmitt R and Lange R (2010) Intermittent regurgitation caused by incomplete leaflet closure of the Medtronic ADVANTAGE bileaflet heart valve: Analysis of the underlying mechanism, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2009.11.001, 140:3, (611-616), Online publication date: 1-Sep-2010. Hansen L, Danne M, Hoffmann B and Rieß F (2007) Structural valve failure with every beat regurgitation observed using the Medtronic Advantage aortic valve, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2007.07.008, 134:5, (1344-1345), Online publication date: 1-Nov-2007. Gerosa G, Carta R, Montisci M, Leoni L, Iliceto S, Rizzoli G and di Marco F (2006) How To Deal With Recipients of Valves Prone to Structural Failure in the 2000s: Padua Experience With the TRI Technologies Valve, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2006.04.055, 82:3, (858-864), Online publication date: 1-Sep-2006. May 10, 2005Vol 111, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000164200.94488.80PMID: 15883218 Originally publishedMay 10, 2005 PDF download Advertisement SubjectsCardiovascular SurgeryEchocardiographyHeart FailureValvular Heart Disease
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