Prosthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve

Area of Science:

• Cardiology
• Biomedical Engineering
• Cardiovascular Surgery

Background:

• Mitral valve replacement (MVR) using Starr-Edwards (SE) caged-disc prostheses is a long-standing procedure.
• Long-term complications of these valves, particularly stenosis, require thorough investigation.
• Understanding the mechanisms of prosthetic valve dysfunction is crucial for patient management.

Observation:

• A 49-year-old male presented with dyspnea 35 years post-MVR with an SE caged-disc valve.
• Echocardiography and catheterization revealed elevated mitral prosthetic valve gradients without disk motion abnormalities.
• Surgical re-exploration identified abnormal fibrinous tissue and mild pannus proliferation within the valve cage.

Findings:

• The SE caged-disc valve exhibited subclinical stenosis due to tissue ingrowth and pannus formation.
• Trans-valvular pressure gradient measurement proved essential for detecting stenosis in the absence of structural abnormalities.
• Histological analysis confirmed fibrinous tissue and pannus as the causative agents of obstruction.

Implications:

• This case highlights the potential for SE caged-disc valves to cause late-onset stenosis, necessitating vigilant long-term monitoring.
• Trans-valvular pressure gradients are a critical, albeit sometimes overlooked, indicator of prosthetic valve function.
• Awareness of this rare complication is vital for cardiologists and cardiac surgeons managing patients with long-term prosthetic valves.