Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization

2015 ◽  
Vol 18 (6) ◽  
pp. 245 ◽  
Author(s):  
Eyup Serhat Calik ◽  
Husnu Kamil Limandal ◽  
Umit Arslan ◽  
Mehmet Tort ◽  
Ziya Yildiz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Femoral Artery ◽  
Prosthetic Valve ◽  
Mechanical Valve ◽  
Complete Recovery ◽  
Emergency Case ◽  
Bileaflet Mechanical Valve ◽  
Left Femoral Artery ◽  
Life Threatening ◽  
Bileaflet Valve

<strong>Background:</strong> Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. <br /><strong>Methods:</strong> A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn’t specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. <br /><strong>Results:</strong> After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. <br /><strong>Conclusion:</strong> The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

The usefulness of cardiac computed tomography in the diagnosis of perivalvular complications in patients with prosthetic valve endocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Zatorska ◽  
T Hryniewiecki ◽  
D Zakrzewski ◽  
M Nieznanska ◽  
M Kusmierczyk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Prosthetic Valve ◽  
Cardiac Computed Tomography ◽  
False Negative ◽  
Prosthetic Valve Endocarditis ◽  
Mechanical Valve ◽  
Inflammatory Infiltration ◽  
Ct System ◽  
Perivalvular Leakage

Abstract Background and purpose of the study Echocardiography remains the gold standard for the diagnosis of prosthetic valve endocarditis (PVE). But in around 15% of cases, its results can be false negative due to the acoustic shadow of artificial valves. The aim of the study was compare cardiac computed tomography (CT) with other imaging modalities in the diagnosis of perivalvular complications in patients with PVE. Material and methods The study included 35 consecutive patients with PVE. Thirty of them had an artificial aortic valve (17- mechanical valve, 13-biological valve), 7-mechanical mitral valve, and one patient was after biological pulmonary valve implantation. Three patients were after aortic and mitral valve replacement. Each patient underwent transthoracic (TTE) and transesophageal (TEE) echocardiography. ECG-gated CT examinations were performed with a dual source CT system. All patients were qualified for surgical treatment. The assessment included the presence of vegetation, perivalvular abscess/pseudoaneurysm, inflammatory infiltration and prosthesis dehiscence. Results Intraoperative assessment revealed the presence of vegetations in 16 patients. The sensitivity of echocardiography (TTE+TEE) and CT examinations was 100% and 93% respectively. Twenty one abscesses/pseudoaneurysms were found intraoperatively. The sensitivity of echocardiography and CT examinations was 76% and 85%, respectively. The analysis of total TTE, TEE and CT findings showed that supplementing echocardiography with CT had increased the sensitivity of the method for detecting abscess/pseudoaneurysms to 95%. In a patient in whom no abscesse was found, inflammatory infiltration was diagnosed in echocardiography. Inflammatory infiltration was diagnosed intraoperatively in 13 patients. The sensitivity of echocardiography and CT was 69% in both examinations. The sensitivity of the combination TTE + TEE + CT was 92%. Perivalvular leakage was found intraoperatively in 17 patients. The sensitivity of echocardiography and CT for the diagnosis of this complication was 100% and 87%, respectively. Conclusions CT is better than echocardiography in diagnosing abscesses/pseudoaneurysms and has the same sensitivity in detecting inflammatory infiltration. Adding CT to echocardiography improves the sensitivity of these complications detection. CT is not superior to echocardiography in the diagnosis of vegetations and perivalvular leakage, but it can be a useful tool when echocardiography findings are inconclusive. Funding Acknowledgement Type of funding source: None

scholarly journals Corynebacterium CDC group G native and prosthetic valve endocarditis

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Adil Sattar ◽  
Siegfried Yu ◽  
Janak Koirala
Keyword(s):  
Mitral Valve ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Mitral Valve Regurgitation ◽  
Venous Access ◽  
High Grade Fever ◽  
Access Port ◽  
First Case ◽  
Life Threatening ◽  
History Of

We report the first case of native and recurrent prosthetic valve endocarditis with <em>Corynebacterium</em> CDC group G, a rarely reported cause of infective endocarditis (IE). Previously, there have been only two cases reported for prosthetic valve IE caused by these organisms. A 69-year-old female with a known history of mitral valve regurgitation presented with a 3-day history of high-grade fever, pleuritic chest pain and cough. Echocardiography confirmed findings of mitral valve thickening consistent with endocarditis, which subsequently progressed to become large and mobile vegetations. Both sets of blood cultures taken on admission were positive for <em>Corynebacterium</em> CDC group G. Despite removal of a long-term venous access port, the patient’s presumed source of line associated bacteremia, mitral valve replacement, and aggressive antibiotic therapy, the patient had recurrence of vegetations on the prosthetic valve. She underwent replacement of her prosthetic mitral valve in the subsequent 2 weeks, before she progressed to disseminated intravascular coagulation and expired. Although they are typically considered contaminants, corynebacteria, in the appropriate clinical setting, should be recognized, identified, and treated as potentially life-threatening infections, particularly in the case of line-associated bacteremias, and native and prosthetic valve endocarditis.

scholarly journals Star GK Bileaflet Mechanical Valve Prosthesis-Patient Mismatch after Mitral Valve Replacement: A Chinese Multicenter Clinical Study

2015 ◽  
Vol 21 ◽  
pp. 2542-2546 ◽  
Author(s):  
Hua Cao ◽  
Zhihuang Qiu ◽  
Liangwan Chen ◽  
Daozhong Chen ◽  
Qiang Chen
Keyword(s):  
Clinical Study ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
Bileaflet Mechanical Valve ◽  
Multicenter Clinical Study

scholarly journals Flow structure in healthy and pathological left ventricles with natural and prosthetic mitral valves

2017 ◽  
Vol 834 ◽  
pp. 271-307 ◽  
Author(s):  
V. Meschini ◽  
M. D. de Tullio ◽  
G. Querzoli ◽  
R. Verzicco
Keyword(s):  
Mitral Valve ◽  
Ad Hoc ◽  
Stokes Equations ◽  
Mechanical Valve ◽  
Left Ventricular ◽  
Navier Stokes ◽  
Navier Stokes Equations ◽  
Mitral Valves ◽  
Bileaflet Mechanical Valve ◽  
Ventricle Volume

In this paper, the structure and the dynamics of the flow in the left heart ventricle are studied for different pumping efficiencies and mitral valve types (natural, biological and mechanical prosthetic). The problem is investigated by direct numerical simulation of the Navier–Stokes equations, two-way coupled with a structural solver for the ventricle and mitral valve dynamics. The whole solver is preliminarily validated by comparisons with ad hoc experiments. It is found that the system works in a highly synergistic way and the left ventricular flow is heavily affected by the specific type of mitral valve, with effects that are more pronounced for ventricles with reduced pumping efficiency. When the ventricle ejection fraction (ratio of the ejected fluid volume to maximum ventricle volume over the cycle) is within the physiological range (50 %–70 %), regardless of the mitral valve geometry, the mitral jet sweeps the inner ventricle surface up to the apex, thus preventing undesired flow stagnation. In contrast, for pathological ejection fractions (⩽40 %), the flow disturbances introduced by the bileaflet mechanical valve reduce the penetration capability of the mitral jet and weaken the recirculation in the ventricular apex. Although in clinical practice the fatality rates in the five-year follow-ups for mechanical and biological mitral valve replacements are essentially the same, a breakdown of the deaths shows that the causes are very different for the two classes of prostheses and the present findings are consistent with the clinical data. This might have important clinical implications for the choice of prosthetic device in patients needing mitral valve replacement.

scholarly journals Acute mitral valve dysfunction due to leaflet escape in a Tri-technologies bileaflet mechanical valve

2007 ◽  
Vol 8 (1) ◽  
pp. 63-66 ◽  
Author(s):  
T CIANCIULLI ◽  
J LAX ◽  
M SACCHERI ◽  
H REDRUELLO ◽  
S BELFORTE ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mechanical Valve ◽  
Valve Dysfunction ◽  
Bileaflet Mechanical Valve ◽  
Leaflet Escape

scholarly journals Fibrinolytic Treatment after Transient Ischaemic Attack Caused by Prosthetic Mitral Valve Thrombosis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Cornel Koban ◽  
Michael Neuß ◽  
Grit Tambor ◽  
Frank Hölschermann ◽  
Christian Butter
Keyword(s):  
Mitral Valve ◽  
Complete Resolution ◽  
Prosthetic Valve ◽  
Prosthetic Valve Thrombosis ◽  
Echocardiographic Examination ◽  
Valve Thrombosis ◽  
Life Threatening ◽  
Ischaemic Attack ◽  
Prosthetic Mitral Valve ◽  
Surgical Valve Replacement

Prosthetic valve thrombosis is one of the most severe complications after surgical valve replacement. There are many possible presentations: from asymptomatic to life-threatening complications. We report on a 61-year-old female patient with prosthetic replacement of the aortic and mitral valve in the in-house department of cardiac surgery 3 months ago. The patient was suffering from aphasia during 5 minutes in domesticity. After her presentation in the emergency room, the echocardiographic examination revealed a thrombotic formation of the prosthetic mitral valve. At presentation, the anticoagulation was outside the effective range (INR: 1.7). A successful thrombolytic therapy with the plasminogen activator urokinase was begun with complete resolution of the thrombus.

Proximal deep venous thrombosis following PTA of the superficial femoral artery – an obligation to disclose a complication that is rarely taken into account

VASA ◽  
2006 ◽  
Vol 35 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Klein-Weigel ◽  
Pillokat ◽  
Klemens ◽  
Köning ◽  
Wolbergs ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Rare Complication ◽  
Femoral Vein ◽  
Vein Thrombosis ◽  
Explicit Information ◽  
Life Threatening ◽  
Legal Consequences

We report two cases of femoral vein thrombosis after arterial PTA and subsequent pressure stasis. We discuss the legal consequences of these complications for information policies. Because venous thrombembolism following an arterial PTA might cause serious sequel or life threatening complications, there is a clear obligation for explicit information of the patients about this rare complication.

Comparative Arterial Antithrombotic Activity of Clopidogrel and Acetyl Salicylic Acid in the Pig

1992 ◽  
Vol 68 (05) ◽  
pp. 500-505 ◽  
Author(s):  
Ch M Samama ◽  
Ph Bonnin ◽  
M Bonneau ◽  
G Pignaud ◽  
E Mazoyer ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Femoral Artery ◽  
Bleeding Time ◽  
Ex Vivo ◽  
Flow Reduction ◽  
Cyclic Flow ◽  
Left Femoral Artery ◽  
Before And After ◽  
The Right ◽  
Induced Aggregation

SummaryWe investigated the comparative antithrombotic properties of clopidogrel, an analogue of ticlopidine, and aspirin, using the Folts' model on femoral arteries in 22 pigs. On each animal, clopidogrel or aspirin were used to treat the thrombotic process on the left femoral artery and to prevent this process on the right femoral artery. Sequentially: an injury and stenosis were carried out on the left femoral artery; the thrombotic process was monitored with a Doppler during a 30-min observation period for cyclic flow reductions or permanent cessation of flow; after the first cyclic flow reduction occurred, clopidogrel (5 mg kg-1) or aspirin (2.5, 5, 100 mg kg-1) were injected intravenously; if cyclic flow reductions were abolished, epinephrine (0.4 µg kg-1 min-1) was injected to try to restore cyclic flow reductions and/or permanent cessation of flow; then injury and stenosis were applied on the right femoral artery. Before and after injection of clopidogrel or aspirin, ear immersion bleeding times and ex-vivo platelet aggregation were performed. Clopidogrel (n = 7) abolished cyclic flow reductions in all animals and epinephrine did not restore any cyclic flow reduction. On the right femoral artery, cyclic flow reductions were efficiently prevented, even for two injuries. Basal bleeding time (5 min 28) was lengthened (>15 min, 30 min after clopidogrel and remained prolonged even after 24 h). ADP-induced platelet aggregation was inhibited (more than 78%). Comparatively, aspirin had a moderate and no dose-dependent effect. Aspirin 2.5 mg kg-1 (n = 6) abolished cyclic flow reductions in 2 animals, CFR reoccurred spontaneously in one animal and epinephrine restored it in a second animal. Aspirin 5 mg kg-1 (n = 6) abolished cyclic flow reductions in only 3 animals and epinephrine always restored it. Aspirin 100 mg kg-1 (n = 3) was unable to abolish cyclic flow reductions. On the right femoral artery, aspirin did not significantly prevent cyclic flow reductions which occurred in all animals after one (n = 14) or two injuries (n = 1), except for one animal. Basal bleeding time was lengthened but it shortened rapidly, reaching its basal value after 24 h. ADP-induced aggregation was not significantly inhibited, whereas arachidonic acid induced aggregation was always inhibited. Clopidogrel appears as a more potent antithrombotic drug than aspirin in this model, in treating and preventing spontaneous or epinephrine-induced cyclic flow reductions and lengthening bleeding time.

scholarly journals Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Shih Yea Sylvia Wu ◽  
Bridget Faire ◽  
Edward Gane
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Final Diagnosis ◽  
Community Acquired Pneumonia ◽  
Drug Induced ◽  
First Case ◽  
Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

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