Non–Life-Threatening Leaflet Escape
A 56-year-old man underwent aortic and mitral valve replacement in 1983. Both valves were replaced with a mechanical convex-concave Bjork-Shiley valve (formerly Shiley Inc).
Eighteen years after this operation, at the age of 74, the patient suddenly experienced interscapular pain associated with a variable but mostly moderate degree of dyspnea. CT scan showed no aortic dissection, but a transthoracic echocardiogram and left heart catheterization revealed a moving object in the left ventricle and intermittent mitral valve regurgitation. In addition, there was a small strut fracture of the mitral valve. The complete small strut escaped from the mitral valve, through the mechanical aortic valve, and was stuck in the descending aorta. The moving object in the left ventricle appeared to be the mitral disc, which at each systole projected toward the mitral valve housing apparatus (Movie). The disc at least partially occluded the mitral valve orifice at each systole. This probably explains the variable and only moderate degree of dyspnea without pulmonary edema. The patient underwent mitral valve replacement with a mechanical ATS mitral valve (ATS Medical Inc) while the aortic valve was left in place. The postoperative course was uneventful.
The movie is available as an online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.