Spontaneous leaflet fracture resulting in embolization from mechanical valve prostheses

Abstract

Spontaneous leaflet fracture of mechanical heart valve prostheses is very rare. We describe a case of spontaneous leaflet embolization 31 years after aortic valve replacement with an Edwards‐Duromedics prosthesis (Baxter Healthcare Corp., Edwards Division, Santa Ana, CA). We review the literature on this subject to increase awareness and recognition for this potentially life‐threatening complication.

Leaflet Fracture and Embolization of a CarboMedics Prosthetic Mitral Valve: Case Report

“…Transthoracic echocardiography is used for diagnosis and to find missing leaflets, and coronary angiography is also used for the diagnosis [1]. According to Van Steenbergen et al [2], most fractured leaflets migrate to the abdominal aorta (13%) or iliac arteries (78%), and in 1 case migration to the brachiocephalic artery occurred. Wholebody computed tomography is a reliable imaging technique to localize escaped leaflets.…”

“…Valve leaflet fractures occurred most frequently with the use of Bjork-Shiley convexoconcave products, followed by Edwards-Duromedics products and TRI Technologies products (TRI Technologies Prosthetic Heart Valve; Ltda, Belo Horizonte, Brazil). Valve fracture is very rare in other products [2].…”

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 ...…”

“…Leaflet escape from prosthetic heart valves is a rare condition that typically results in severe valvular regurgitation and pulmonary edema. 1 , 2 Leaflet embolization is most commonly caused by a mechanical valve defect but can result from operative manipulation as well. The standard treatment approach after leaflet escape has been identified is an emergent replacement of the faulty valve and removal of the valve fragments.…”

“…The standard treatment approach after leaflet escape has been identified is an emergent replacement of the faulty valve and removal of the valve fragments. 1 The fragment can be difficult to locate, but computed tomography (CT) scans have historically had the greatest success compared with plain radiography, angiography, and ultrasound. 3 If the fragment is not found and is left in the patient's circulation, there is increased risk of infection, thrombosis, and migration.…”