Metallic embolus to the brain in a patient with mechanical heart valves: an extremely rare complication

Abstract

A 46-year-old man with a medical history of rheumatic valve disease underwent mitral and aortic valve replacements with On-X and CarboMedics Top Hat supra-annular mechanical valves, respectively. Seven months after the valve replacement surgery, the patient presented with dizziness. A CT scan of the brain was done as part of a thorough workup of dizziness. The CT scan revealed a small metallic density in the M2 branch of the right middle cerebral artery. The metallic density was believed to be a metallic embolus that originated from the mechanical valves or the suturing material, that is, Cor-Knot fastener. Although in our case, the dizziness was believed to be the result of benign paroxysmal positional vertigo, through this case, we aim to highlight this extremely rare structural complication of mechanical valves. This complication can have serious and potentially fatal consequences such as embolic component-related stroke or another organ infarction.

Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

“…Metallic embolus that may be originated from the heart valve prosthesis, suture materials and/or CORKNOT® has been reported to the literature few times [ 7 , 24 ]. Despite the fact that COR-KNOT® was proven in Ex-vivo model [ 4 , 25 ] in terms of its sutures security, strength, and consistency; such detrimental rare event may happen.…”

“…The two cases reported the embolization by Garrett et al [ 7 ] and Sagheer et al [ 24 ] were not identical, the former was a robotic assisted procedure whereas the later was a traditional open heart surgery. Sagheer et al [ 24 ] didn’t confirm the resulted embolus was CORKNOT® as the patient was believed to have paroxysmal positional vertigo, but the embolus had a metal density.…”

The role of Cor‐Knot in the future of cardiac surgery: A systematic review

“…Cor-Knot is the potential for complications, with multiple cases of metallic emboli 28,29 and leaflet perforation being reported. [15][16][17][18] LSI Solutions acknowledge an overall incidence of 0.00015% for adverse events whilst using Cor-Knot for any given procedure.…”

“…7 Additionally, Sagheer et al reported a case of a metallic brain embolus originating either from a mechanical heart valve or a titanium clip in a patient who underwent aortic valve and MV replacement 7 months beforehand. 29…”

“…It is thought that these problems arose as a result of the surgeon's inexperience with the device 6 and, according to LSI Solutions, appropriate fastener orientation will prevent such complications 7 . Additionally, Sagheer et al reported a case of a metallic brain embolus originating either from a mechanical heart valve or a titanium clip in a patient who underwent aortic valve and MV replacement 7 months beforehand 29 …”