Cardiogenic Shock Due to Leaflet Migration of On-X Aortic Mechanical Prosthesis

Leaflet fracture and embolization from an On-X mechanical mitral valve

“…This is the first case of leaflet fracture that we have observed in this prosthesis, and only the fourth such case published in the literature to date. One other reported failure involved the On-XMC 25/33, which has the conform sewing ring 2 ; the devices used in the other 2 cases (one in the aortic position 4 and the other in the mitral position 3 ) are not known.…”

“…Only 3 previous cases of leaflet embolization from On-X mechanical valves have been reported, 2 in a mitral position and 1 in an aortic position. 2 , 3 , 4 Here we report the fourth case, involving only the second patient to survive and recover from surgery.…”

Commentary: How can you mend a broken heart: Mechanical valve leaflet fracture

“… 2 Although older mechanical valves had a greater propensity of valve fracture and embolization, newer generation models can also be at risk for this complication, as seen by this report and others. 3 , 4 , 5 , 6 …”

“…Leaflet fracture can occur at any time after prosthetic valve implantation and must remain a part of the differential diagnosis for acute prosthetic valve mitral regurgitation. 4 , 5 , 6 Transesophageal echocardiography and non–contrast-enhanced computed tomography are necessary tools for an accurate diagnosis, and the appropriate management is similar to that for acute mitral regurgitation secondary to valve thrombosis. Given the mortality of 50% in the reported data, a rapid, and accurate diagnosis, as well as appropriate initial management, offers the best chance for optimal patient outcomes.…”

“…Given the mortality of 50% in the reported data, a rapid, and accurate diagnosis, as well as appropriate initial management, offers the best chance for optimal patient outcomes. 4 , 5 , 6 …”