J Cardiovasc Ultrasound.  2013 Jun;21(2):96-99.

Prosthetic Mitral Valve Leaflet Escape

• Kim D
• Hun SS
• Cho IJ
• Shim CY
• Ha JW
• Chung N
• Ju HC
• Sohn JW
• Hong GR

Abstract

Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well.

Keyword

Cardiac valve prosthesis; Prosthesis failure; Cardiogenic shock

MeSH Terms

Echocardiography, Transesophageal
Heart Failure
Heart Valve Prosthesis
Humans
Iliac Artery
Mitral Valve
Prosthesis Failure
Shock, Cardiogenic
United Nations

Figure

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  Fig. 1 Chest radiography shows acute pulmonary edema with cardiomegaly.

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  Fig. 2 A: Apical four chamber zoom Doppler: no significant mitral regurgitant jet flow is demonstrated, however, mitral regurgitation is suspected despite poor echo window due to posterior acoustic shadowing and tachycardia. B: Continuous wave Doppler demonstrating pressure gradient across prosthetic mitral valve was elevated (mean diastolic pressure gradient 10 mmHg) without prolongation of pressure half time (54 ms). This finding favors regurgitation rather than obstruction. C: Continuous wave Doppler indicating low peak velocity and rapid decline in velocity in late systole, suggesting acute severe mitral regurgitation.

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  Fig. 3 Edward-Duromedics mitral valve retrieved from the emergent surgery.

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  Fig. 4 Computed tomography locating the missing leaflet of the prosthetic valve in infrarenal abdominal aorta. White arrow indicates the missing leaflet.

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  Fig. 5 The remaining fragment of leaflet in infra renal abdominal artery was removed from placed 2 cm above common iliac artery bifurcation.

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