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Sundaram M, Poddar A, Robinson A, Balakrishnan S, Srinivasan M, Padmanabhan C. An unusual cause of acute mitral regurgitation in TTK Chitra heart valve prosthesis. Indian J Thorac Cardiovasc Surg 2021; 37:546-550. [PMID: 34511762 DOI: 10.1007/s12055-020-01134-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022] Open
Abstract
Structural failure of mechanical heart valve was a known feature when it was evolving in the 1960s and 1970s. With the advent of pyrolytic carbon and a better design, it is a rare entity with present valves. We report a case of disc fracture leading to acute mitral regurgitation in TTK Chitra heart valve prosthesis (CHVP) (TTK Healthcare Limited, India) heart valve, 6 years after its implantation in mitral position.
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Affiliation(s)
- Muthukumar Sundaram
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Pappanaickenpalayam, Coimbatore, Tamil Nadu 641037 India
| | - Aayush Poddar
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Pappanaickenpalayam, Coimbatore, Tamil Nadu 641037 India
| | - Ancy Robinson
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Pappanaickenpalayam, Coimbatore, Tamil Nadu 641037 India
| | | | - Muralidharan Srinivasan
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Pappanaickenpalayam, Coimbatore, Tamil Nadu 641037 India
| | - Chandrasekar Padmanabhan
- Department of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Nethaji Road, Pappanaickenpalayam, Coimbatore, Tamil Nadu 641037 India
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Abstract
The US Food and Drug Administration (FDA) has defined a medical device as a health care product that does not achieve it's purpose by chemical action or by being metabolized. This means that a vast number of products are considered medical devices. Such devices play an essential role in the practice of medicine. The FDA classifies medical devices in three classes, depending on the risk of the device. Since Class I and II devices have relatively simple requirements for getting to the market, this review will focus on "implantable devices", which, in general, belong to Class III. The European Union and Canada use a slightly different classification system. While early generations of medical devices were introduced without much testing, either technical or clinical, the process of introducing a Class III medical device from concept to clinical practice has become strongly regulated and requires extensive technological and clinical testing. The modern era of implantable medical devices may be considered to have started in the 1920s with development of artificial hips. The implantable pacemaker was another milestone and pacemakers and cardioverters/defibrillators have since saved millions of lives and created commercial giants in the medical device industry. This review will include some examples of cardiovascular devices. Similar considerations apply to the total implantable device market, although clinical and technological applications obviously vary considerably.
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Affiliation(s)
- Jacob Bergsland
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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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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Emergency recognition and treatment of strut fracture and disc embolization in patients with Bjo¨rk-Shiley valve prosthesis. Am Heart J 1992. [DOI: 10.1016/0002-8703(92)90094-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Miller SF, McCowan TC, Eidt JF, Cook JM, Carver DK. Embolization of a prosthetic mitral valve leaflet: localization with intravascular US. J Vasc Interv Radiol 1991; 2:375-8. [PMID: 1799784 DOI: 10.1016/s1051-0443(91)72266-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The authors describe a case in which a leaflet from a mitral valve prosthesis embolized to the right external iliac artery. Intravascular ultrasound proved useful in locating the valve fragment prior to and during surgery, allowing for its removal.
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Affiliation(s)
- S F Miller
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock 72205
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Kien GA, Jeffries B, Katz HV, Herman BA, Carey RF, Chwirut DJ, Bushar HF. Digital acoustical analysis of normal and bimodal Björk-Shiley 60 degrees convexo-concave heart valves. Am J Cardiol 1990; 66:849-54. [PMID: 2220584 DOI: 10.1016/0002-9149(90)90363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fracture of the outlet strut of the Björk-Shiley 60 degrees convexo-concave (BS60CC) valve has been attributed to a bimodal closing pattern in certain valves in which the closing disk rotates about the inlet strut, causing upward displacement of the outlet strut and its eventual fracture. This article reports the in vivo studies of the normal BS60CC valve and the in vitro studies of the normal and bimodal BS60CC valves, using a digital acoustical signal processing technique, in which the individual collisions (impact history) of the occluder disk with the components of the valve body are revealed during each closing cycle. In vitro analysis of the closing acoustical signals of normal BS60CC valves showed impact history cluster width (IHCW) means of 2.07 +/- 0.85 ms (standard error), not significantly different from those of 1.86 +/- 0.58 ms (standard error) observed in 38 clinically normal patients with BS60CC valves (p greater than 0.1). The bimodal valves showed IHCW of 6.14 +/- 0.98 ms (standard error), in vitro, which was significantly greater than those observed in the normal in vitro valve group and in the normal patient population (p less than 0.0001).
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Affiliation(s)
- G A Kien
- International Acoustics Incorporated, Palatine, Illinois
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Abstract
Embolization of a prosthetic valve poppet is a rare but life-threatening event. It was reported sporadically before the introduction of the Björk-Shiley 70-degree convexoconcave prosthesis in 1980. Since that time, there have been a large number of reported mechanical failures with disc escape. The rate for the 29-mm to 33-mm mitral valves is estimated as 5.2%. In 29 of 35 patients (including the 2 presented here) in whom the site of disc lodgment could be determined, the disc was in the descending or abdominal aorta. Fifteen of these patients died. Six survivors had the disc removed at the same operation and 6 at a later operation. In 2 patients, the disc was not removed. In 2 patients in whom the disc was not removed initially, it was thought to contribute to postoperative complications. Two more cases of structural failure of the Björk-Shiley convexoconcave prosthesis are presented. A transpericardial approach to the descending aorta on bypass is described. It allows easy removal of the disc and eliminates the need for a second operation.
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Affiliation(s)
- P N Hendel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Schurawitzki H, Hajek PC, Kramer J, Grabenwöger F, Klepetko W, Moritz A. Radiologic search for embolized leaflets of prosthetic heart valves: a report of two cases. Cardiovasc Intervent Radiol 1989; 12:10-3. [PMID: 2496920 DOI: 10.1007/bf02577118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a radiologic search for embolized leaflets of Edwards-Duromedics bileaflet valves in 2 patients, the embolized fragments were localized in the iliac vessels using computed tomography. Sonography was successful in one case and standard X-ray films of the abdomen were negative in both cases. In vitro investigations with Björk-Shiley and Edwards-Duromedics leaflets suggested that standard X-ray films of the abdomen and pelvis should be considered as the first investigational technique. If negative, computed tomography of the lower abdomen should be done.
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Affiliation(s)
- H Schurawitzki
- Central Institute for Radiodiagnostics, University of Vienna, Austria
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Au J, Sang CT. Strut fracture and disc embolisation of a Björk-Shiley aortic prosthesis: emergency operation with survival. Case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1989; 23:297-8. [PMID: 2617253 DOI: 10.3109/14017438909106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Strut fracture with disc embolisation from a Björk-Shiley prosthesis in the aortic position is extremely rare, and almost invariably fatal. We report a case in which the patient survived emergency surgery for this complication. The pathogenesis of strut fracture, its prevention, diagnosis and management are discussed.
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Affiliation(s)
- J Au
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, U.K
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Hiratzka LF, Kouchoukos NT, Grunkemeier GL, Miller DC, Scully HE, Wechsler AS. Outlet strut fracture of the Björk-Shiley 60 degrees Convexo-Concave valve: current information and recommendations for patient care. J Am Coll Cardiol 1988; 11:1130-7. [PMID: 3281994 DOI: 10.1016/s0735-1097(98)90075-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mechanical failure of artificial heart valves can be a catastrophic event. The problem of outlet strut fracture of the Björk-Shiley 60 degrees Convexo-Concave tilting disc prosthesis has received much attention in the medical literature and generated both concern and confusion among patients and physicians. Analysis of current data from the manufacturer, as well as a review of the medical literature, suggests that the overall risk of outlet strut fracture is low and that elective explantation of a well functioning Björk-Shiley 60 degrees Convexo-Concave valve prosthesis is not warranted. Diagnostic features of outlet strut fracture can be seen with overpenetrated chest X-ray films so that diagnosis can be established promptly. Early operation to replace the fractured prosthesis is essential for patient survival.
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Ruiz CE, Boltwood CM, Lau FY. Percutaneous double balloon aortic valvuloplasty in an adult patient with calcific aortic stenosis and a Bjork-Shiley prosthetic mitral valve. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1988; 15:265-70. [PMID: 3228859 DOI: 10.1002/ccd.1810150411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Percutaneous transluminal balloon valvuloplasty is a new technique in interventional cardiology which to date has been applied successfully in the dilatation of all four cardiac valves. Although the different techniques appear to be quite effective, the safety of these procedures has not been fully explored. In particular, because of the close anatomic relationship of the aortic and mitral annuli, the safety of aortic valvuloplasty in patients with mitral valve prosthesis is unknown. Therefore, we report the applicability of a percutaneous double balloon valvuloplasty in an elderly patient with calcific aortic stenosis and a Bjork-Shiley mitral valve prosthesis.
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Affiliation(s)
- C E Ruiz
- Department of Medicine, White Memorial Medical Center-Loma Linda University School of Medicine, Los Angeles, California
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Abstract
Cardiac valve replacement with mechanical prosthetic or bioprosthetic devices enhances patient survival and quality of life. Nevertheless, prosthesis-associated complications are frequent and contribute significantly to outcome. Thromboembolic complications are the most important problems in patients with mechanical valves, necessitating chronic anticoagulation in all patients receiving them. In contrast, patients with bioprosthetic valves, composed of chemically treated animal tissues, generally do not require anticoagulants. However, bioprostheses fail frequently by degeneration, especially that involving cuspal calcification. This paper reviews the pathological and bioengineering considerations in the selection of cardiac prosthetic valves and the management of patients who have received these devices. The significance, morphology, and pathogenesis of the observed major complications and other alterations during function are described in detail. Contemporary investigative trends are summarized, including studies of inhibition of mineralization and other degenerative changes in bioprostheses, improved design rigid mechanical valves with pyrolytic carbon occluders and the development of central-flow, flexible polymeric leaflet valves.
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Affiliation(s)
- F J Schoen
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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