Abstract
We report the case of a patient who underwent a redo surgery for a leaflet escape from a Bjork-Shiley tilting disc mitral prosthesis inserted 18 years previously. The escaped disc remained lodged in the thoracic aorta without any complication. She ultimately died of terminal heart failure 13 years after the second operation. We believe this to be the longest survival with a dislodged leaflet from a mechanical valve. Removal of dislodged disc is recommended in literature but there may be a place for watchful observation in exceptional cases with no haemodynamic compromise.
Highlights
Leaflet escape from a prosthetic valve is a rare but lifethreatening event
Treatment is by emergency replacement of the prosthesis and retrieval of the escaped leaflet
A 52 year old lady underwent mitral valve replacement with a 23 mm Björk-Shiley prosthesis18 years previously for rheumatic mitral stenosis. She had suffered with refractory supraventricular tachyarrhythmias and a transeptal AV node ablation was attempted. She became acutely unwell during the procedure, with cardiogenic shock and pulmonary oedema, which proved to be due to escape of the disc-occluder from the valve prosthesis during the cardiological maneuver
Summary
Leaflet escape from a prosthetic valve is a rare but lifethreatening event. Treatment is by emergency replacement of the prosthesis and retrieval of the escaped leaflet. A 52 year old lady underwent mitral valve replacement with a 23 mm Björk-Shiley prosthesis years previously for rheumatic mitral stenosis She had suffered with refractory supraventricular tachyarrhythmias and a transeptal AV node ablation was attempted. She became acutely unwell during the procedure, with cardiogenic shock and pulmonary oedema, which proved to be due to escape of the disc-occluder from the valve prosthesis during the cardiological maneuver. She underwent emergency surgery to replace the damaged valve with a bileaflet device, but the escaped disc could not be found It was later localized by trans-esophageal echocardiography to the descending thoracic aorta, with its long axis parallel to the long axis of aorta, not interrupting the flow.
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