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Stuck leaflet of bileaflet prosthesis in mitral position – five cases to make us think

Centre of Thoracic Surgery, S.João Hospital, 4202-451, Oporto, Portugal

*Corresponding author. Centro de Cirurgia Torácica, Hospital de S.João, 4202-451, Porto, Portugal. Tel.: +351-2-5502417; fax: +351-2-5502254.

E-mail address: jalmeida{at}hsjoao.min-saude.pt (J. Almeida).

Objective: We present five cases of mitral bileaflet prosthesis dysfunction as a result of a stuck leaflet in closed position, diagnosed at surgery or during the first postoperative year. Methods and results: The diagnosis was made by echocardiography and could be confirmed by fluoroscopy in three patients. All cases had in common an early occurrence and the presence of a clean prosthesis by transesophageal echocardiography (TEE). In one patient the diagnosis was made by intraoperative TEE, and the problem could be solved by rotation of the occluding device. In the other four patients the diagnosis was made postoperatively and different strategies of treatment were taken. All but one case were reoperations, one had a dysfunctional biological prosthesis and three had been submitted to mitral valvoplasty (two rheumatic and one degenerative valves). According to our policy, patients started sodium warfarin therapy 24 h after surgery in order to keep International normalized ratio (INR) values between 2.5–3.5. Only in one case the presence of thrombus/pannus could be confirmed. Conclusions: We call the attention to causes other than thrombosis that can provoke leaflet block and to the importance of performing intraoperative TEE in patients submitted to mitral valve replacement. We also emphasize the fact that a stuck leaflet in a clean prosthesis can evolve without major symptoms or cardiac events.

Key Words: Prosthesis dysfunction; Stuck leaflet