Immobilization of disc heart valves by unraveled sutures

Disc immobilization by a prolapsed suture end was observed in a laboratory animal with a pivoting disc heart valve. An identical occurrence was experienced in a clinical situation by other investigators. These experiences prompted a review of sutures and suturing techniques in implanting disc heart valves, in an effort to ascertain the vulnerability of all disc valves toward disc immobilization by sutures. An attempt was made to immobilize the discs in five currently available heart disc valves with prolapsed sutures under various handling conditions. Variables included the model of disc valve, the location of the prolapsed suture, and the type of suture material used. Our investigation showed that any of the valves studied can be immobilized by prolapsed sutures. However, this complication is avoidable if the implanting surgeon adheres to a few precautionary suturing principles.