Intraoperative detection of stuck leaflet after implantation of a mechanical aortic valve: a case report

Kazuto Miyata,Sayaka Shigematsu

doi:10.1186/s40981-020-0313-3

Abstract

BackgroundMechanical aortic valve dysfunction is a rare but potentially fatal complication. It is usually caused by thrombosis, vegetation, and pannus overgrowth. However, it very rarely occurs immediately after the cardiopulmonary bypass weaning period.Case presentationWe describe a case of stuck leaflet after the implantation of a mechanical aortic valve because of residual suture materials interfering with mechanical aortic valve leaflet closure, which is a very rare cause and has not been reported until now.ConclusionThe residual suture materials for mechanical aortic valve replacement could cause mechanical valve dysfuction indicated as stuck leafet.

Highlights

BackgroundEvaluation using intraoperative transesophageal echocardiography (IO-Transesophageal echocardiography (TEE)) of a mechanical heart valve immediately after cardiopulmonary bypass (CPB) weaning is needed to make a decision on whether repeat CPB is required
Mechanical aortic valve dysfunction is a rare but potentially fatal complication
IO-Transesophageal echocardiography (TEE) shows that normal transvalvular leaks occur from hinge points, and the degree of leakage is usually trivial and symmetric in mechanical prosthetic valves

Summary

Background

Evaluation using intraoperative transesophageal echocardiography (IO-TEE) of a mechanical heart valve immediately after cardiopulmonary bypass (CPB) weaning is needed to make a decision on whether repeat CPB is required. IO-TEE shows that normal transvalvular leaks occur from hinge points, and the degree of leakage is usually trivial and symmetric in mechanical prosthetic valves. We report a very rare case of stuck leaflet of prosthetic aortic valve, and IO-TEE show that abnormal transvalvular leakage caused by residual suture materials interfering with leaflet closure, which has not been reported until now. IOTEE was performed to study the new prosthetic aortic valve before weaning off CPB (Fig. 1). The mid-esophageal aortic valve short-axis view revealed that the mechanical bileaflet prosthetic valves were inserted in an ordinary position, which indicated that the two hinges were not located on the coronary ostia. After re-aortic-cross-clamping and aortotomy, residual suture material placed in the sewing ring was observed to be caught in one leaflet, interfering with the closing of the leaflet.

Discussion

Conclusion