Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization

Abstract

The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

Embolized mechanical aortic valve leaflet causing infrarenal aortic stenosis and claudication

“…of cases Mechanical valve position Location of embolized fragments Fragment retrieved? Time from valve replacement to fragment retrieval Patient outcome Yildiz et al 6 1 Mitral Aorta bifurcation No N/A Death 1 week after operation due to pneumonia and respiratory failure Tsui et al 3 2 Mitral Aorta bifurcation Yes 17 days Successful recovery Aortic Right SFA Yes 9 days Successful recovery Pawale et al 7 1 Mitral Thoracic aorta Yes 6 days Successful recovery Cianciulli et al 8 1 Mitral Aorta bifurcation Yes 3 months Successful recovery van Steenbergen et al 1 1 Aortic Part in left SFA, part in left popliteal artery Left SFA fragment retrieved NR, <1 year Successful recovery Calik et al 9 1 Mitral Left femoral artery Yes 15 days Successful recovery Klepetko et al 10 2 Mitral ...…”

Fracture of an Edwards Duromedics Mitral Prosthesis Leaflet

“…Unlike a bioprosthesis, a mechanical valve prosthesis is deemed to undergo no structural valve deterioration and offers lifelong durability, unless it is affected by external factors such as endocarditis, thrombosis, or surgical malpractice ( 1 ).…”

“…Thus, leaflet escape remains an exceptional but life-threatening complication, with an incidence that does not exceed 0.3% ( 1 ) and a surgical mortality of up to 17% ( 2 ).…”

“…Previous studies reported a higher incidence of leaflet fracture in mechanical mitral valves than in aortic valves. Although the mechanism is still unclear, the mitral prosthesis experienced higher systolic pressure ( 1 , 2 , 3 ). The patient showed the longest period ever reported among 16 similar cases in the original ED prosthesis ( 2 ).…”

“…Two important factors should be considered in leaflet escape: hemodynamic changes related to acute severe regurgitation and consequences of the migration of the leaflet ( 1 ). The most common sites of migration are abdominal aorta and iliofemoral axes, unless the leaflet breaks into small pieces ( 2 ).…”