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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve
Tomás Francisco Cianciulli1, Jorge Alberto Lax, María Cristina Saccheri
1Researchers of the Secretary of Health, Government of the City of Buenos Aires, Argentina. tcianciulli@fibertel.com.ar
Summary
Mechanical prosthetic valve failure from leaflet escape, a rare but fatal complication, occurred in a patient who stopped anticoagulation. This case highlights the critical need for adherence to anticoagulation therapy to prevent severe structural valve failure and cardiogenic shock.
Area of Science:
- Cardiology
- Biomedical Engineering
- Mechanical Engineering
Background:
- Mechanical prosthetic valves are used to treat valvular heart disease.
- Structural valve failure can lead to significant morbidity and mortality.
- Leaflet escape is a rare but critical mode of mechanical prosthetic valve failure.
Observation:
- A 32-year-old patient presented with cardiogenic shock three years after mitral valve replacement with a bileaflet mechanical valve.
- The patient had discontinued oral anticoagulation therapy four months prior to admission.
- Echocardiography revealed acute massive mitral regurgitation with preserved left ventricular function.
Findings:
- Emergency surgery identified a missing leaflet and a second leaflet immobilized by a prosthetic thrombus.
- This represents a case of acute prosthetic valve dysfunction due to leaflet escape and thrombosis.
- The patient's history of non-adherence to anticoagulation was a significant contributing factor.
Implications:
- This case underscores the critical importance of lifelong oral anticoagulation therapy in patients with mechanical prosthetic heart valves.
- Discontinuation of anticoagulation significantly increases the risk of prosthetic valve thrombosis and structural failure.
- Prompt diagnosis and surgical intervention are crucial for managing acute prosthetic valve dysfunction to improve patient outcomes.
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