Optimal imaging techniques for locating leaflets after escape from prosthetic heart valves

The authors report two cases of leaflets escaping from an Edwards-Duromedics bileaflet prosthetic heart valve (Baxter-Edwards Division, Baxter Healthcare Corp., Irvine, Calif.). Several imaging techniques were used in attempts to locate the leaflets. Only computed tomography (CT) led to conclusive results. Because progressive extrusion through the arterial wall was documented surgically in these cases, the authors recommend that CT be performed as early as possible after a leaflet escapes, even in asymptomatic patients. Extrusion through the arterial wall precludes percutaneous intravascular movement or retrieval of escaped leaflets.