Fractured strut of Björk-Shiley 70 degrees convexo-concave mitral valve prosthesis found in left coronary artery. Use of a portable transcutaneous cardiopulmonary bypass system for successful valve replacement.
Strut fractures followed by disk escape of Björk-Shiley convexo-concave valve prostheses are a well-known problem. This article discusses the case of a successfully treated patient who was admitted to our institution with extreme and prolonged cardiogenic shock. The strut was dislodged into the main stem of the left coronary artery and the disk into the iuxtarenal abdominal aorta. The intent of this report is, in particular, to illustrate the management problems. Immediately after diagnosis, circulation and oxygenation were ensured by use of a portable cardiopulmonary bypass support (CPS) system whose circulation lines were introduced subcutaneously. Thus the transfer to the operating room and the surgical intervention were able to start under controlled conditions. The disk was removed by Fogarty catheter manoevre without any problems during the same operation, using a transpericardial access to the descending thoracic aorta. In our opinion, the primary insertion of the CPS and the avoidance of an additional laparotomy in disk removal help promote the survival of such critically ill patients.
Herse
B
B
Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Germany.
Baryalei
M
M
Wiegand
V
V
Autschbach
R
R
D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D003331:Coronary Vessels; D004630:Emergencies; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011654:Pulmonary Edema / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery