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Torres JA, Arevalo A, Sastre JA, González-Porras JR, Salvador R, González-Santos J, Lozano FS. 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 2020; 61:256-263. [PMID: 31985187 DOI: 10.23736/s0021-9509.20.11026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on the case of spontaneous rupture of an On-X-pure pyrolytic carbon mechanical valve prosthesis implanted seven years earlier, in a mitral position, at our hospital. The patient was admitted with valvular dysfunction and acute pulmonary edema requiring emergency surgery (prosthesis replacement); the absence of a leaflet was confirmed intraoperatively. The patient presented severe respiratory failure, which prolonged the postoperative period. A CT scan showed that the migrated leaflet was located in the aortic bifurcation with no apparent arterial lesion. Four months later, once the patient had recovered, laparotomy and aortotomy were performed in order to retrieve the leaflet, which was found to have become included (neoendothelized) in the aortic wall without compromising the latter's integrity or obstructing the blood flow. A subsequent CT scan confirmed the persistence of the leaflet in its initial position. The literature review highlights two singular facts: 1) this is the second published case of the escape of a leaflet from an On-X prosthesis (the first patient died); 2) this is the first case in which a laparotomy was performed to retrieve the leaflet but finally a decision was made to leave it in situ. Seven months later, the patient remained asymptomatic.
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Affiliation(s)
- José A Torres
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
| | - Adolfo Arevalo
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Cardiac Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - José A Sastre
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Anesthesiology, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - José R González-Porras
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Hematology, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - Roberto Salvador
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
| | - José González-Santos
- Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain.,Department of Cardiac Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain
| | - Francisco S Lozano
- Department of Angiology and Vascular Surgery, Salamanca University Hospital (CAUSA), Salamanca, Spain - .,Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca (USAL), Salamanca, Spain
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Hui DS, Miles KM, Lee R. Neurologic Injury Predicts Plaintiff Award in Federal Cardiac Surgery Trials. Ann Thorac Surg 2018; 106:691-695. [DOI: 10.1016/j.athoracsur.2018.03.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 02/03/2023]
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Geiger A, Zarubin A, Hammel D, von Bally G, Scheld H. Holographic interferometry for in vitro investigations of prosthetic heart valves. Int J Angiol 2011. [DOI: 10.1007/bf02651553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bridgewater BJ, Levy RD, Hooper TL. Mitral valve prosthesis disk embolization during transeptal atrioventricular junction ablation. J Interv Cardiol 1994; 7:535-7. [PMID: 10155201 DOI: 10.1111/j.1540-8183.1994.tb00493.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case of disk embolization from a Bjork-Shiley mitral valve prosthesis (Shiley Inc., Irvine, CA, USA) which occurred during transeptal atrioventricular (RV) junction ablation. The disk lodged in the lower thoracic aorta. The patient was treated successfully by emergency valve replacement, and the escaped disk has been left in situ with no complications.
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Affiliation(s)
- B J Bridgewater
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, United Kingdom
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Wilson HA, Werbel B, Hudspeth AS, Haponik EF. Acute cardiogenic shock in a 62-year-old man. Chest 1993; 103:1237-8. [PMID: 8131472 DOI: 10.1378/chest.103.4.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- H A Wilson
- Section of Pulmonary/Critical Care, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC
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Nakano S, Kawashima Y, Matsuda H, Sakai K, Taniguchi K, Kawamoto T, Shintani H, Mitsuno M, Ueda T. A five-year appraisal and hemodynamic evaluation of the Björk-Shiley Monostrut valve. J Thorac Cardiovasc Surg 1991. [DOI: 10.1016/s0022-5223(19)36660-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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