Escape of the disc occluder from a Beall model 104 mitral prosthesis

A case of the escape of the disc occluder from a Beall model 104 mitral valve implanted 12 years earlier is reported. Acute dysfunction of the prosthesis was diagnosed and prompt operation was carried out. The patient, who was admitted in cardiogenic shock and pulmonary edema, survived and had a smooth postoperative course. Unnecessary investigations, which result in a delay of surgery, should be avoided under these circumstances. Since escape of the disc is rare with this type of valve (only one case has previously reported) elective reoperation is not recommended, but attention should be paid to the appearance of premonitory symptoms which may precede this dramatic event. Various investigations failed to located the embolized disc. Since no evidence of arterial obstruction was present, the patient was not submitted to an exploratory operation.