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European Journal of Echocardiography 2008 9(1):65-68; doi:10.1016/j.euje.2006.08.018
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2006. For permissions please email: journals.permissions@oxfordjournals.org.

Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve

Tomás F. Cianciulli1,*,{dagger}, Jorge A. Lax1, María C. Saccheri1,{dagger}, Robert Guidoin2, César M. Salvado1, Adrián J. Fernández1 and Horacio A. Prezioso1

1 Departments of Cardiology and Cardiovascular Surgery, Hospital del Gobierno de la Ciudad de Buenos Aires ‘Dr. Cosme Argerich’, Buenos Aires, Argentina
2 Department of Surgery, Laval University and Quebec Biomaterials Institute, Saint-Francois d'Assise Hospital, Quebec, Canada

Received 17 August 2006; accepted after revision 29 August 2006; online publish-ahead-of-print 11 October 2006.

* Corresponding author. Department of Cardiology, Echocardiography Laboratory, Hospital del Gobierno de la Ciudad de Buenos Aires ‘Dr. Cosme Argerich’, Av. Alte. Brown 240 (C1155ADP), Buenos Aires. Argentina. Tel: +54 11 4801 5510; fax: +54 11 4801 4157. E-mail address: tcianciulli{at}fibertel.com.ar


  Abstract

The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed prosthetic valve. The missing leaflet could not be found within the cardiac cavity.

The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation.To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.

Keywords: Leaflet escape; Acute prosthetic valve dysfunction; Tri-technologies; Embolization; Ultrasonography; Computed tomography

{dagger} Researchers of the Secretary of Health, Government of the City of Buenos Aires.


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