Cianciulli Tomás F, Lax Jorge A, Saccheri María C, Guidoin Robert, Salvado César M, Fernández Adrián J, Prezioso Horacio A
Department of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.
Eur J Echocardiogr. 2008 Jan;9(1):65-8. doi: 10.1016/j.euje.2006.08.018.
The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed 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. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation. To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.
人工心脏瓣膜瓣叶脱出是人工瓣膜功能障碍的原因之一，需要进行紧急手术。由于存在主动脉壁渐进性挤压的风险，应取出栓塞的瓣叶。可使用多种成像技术来检测缺失瓣叶的位置。在本报告中，我们描述了一名32岁男性，他三年前接受了三技术双叶瓣二尖瓣置换术，现因心源性休克入院。经食管超声心动图显示急性发作的大量二尖瓣反流。该患者接受了人工瓣膜紧急置换术。取出的人工瓣膜中仅剩下两片瓣叶中的一片。在心脏腔内未发现缺失的瓣叶。腹部荧光透视检查和X线平片未能检测到脱出的瓣叶。腹部计算机断层扫描和超声显示脱出的瓣叶位于主动脉分叉的末端。三个月后进行剖腹手术和主动脉切开术以取出栓塞的瓣叶。脱出的瓣叶显示其中一个枢轴系统因结构故障而骨折。这种故障模式通常是高应力集中的结果。
