title: [The leaflet fracture of a 19 mm SJM (HP) valve during valve insertion to the calcified small aortic annulus].
abstract: Aortic valve replacement was undergone in a 70-year-old woman with calcified aortic stenosis. Calcified and fused tricuspid aortic valve was excised and a 21 mm sizer passed with some difficulty through the annulus. A 19 mm SJM HP serious was selected and the horizontal mattress suturing technique was used. The valve was held at the cuff near the hinge guard and seated into the annulus by the usual amount of pressure, however, one leaflet fracture was retrieved and the valve was removed. A 19 mm standard SJM valve was then successfully implanted. The potential factors of leaflet fracture suggested that the leaflet thickness of smaller sized SJM valves showed smaller values than other bileaflet valves in the same sized-valves. In addition, the SJM valve does not have an orifice stiffening ring like other bileaflet valves. So, needless to say direct pressure to the leaflet, indirect pressure might cause valve destruction during insertion. The abnormal pressure applied to the direction from one hinge guard to the other can introduce deforming of the orifice ring resulting in leaflet fracture like this case. The pressure directed to the perpendicular direction may introduce leaflet escape due to the deforming of the valve orifice.
authors.affiliation: Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Akiyama
authors.forename: J
authors.initials: J
authors.lastname: Hirota
authors.forename: M
authors.initials: M
authors.lastname: Takiguchi
authors.forename: S
authors.initials: S
authors.lastname: Ohsawa
authors.forename: A
authors.initials: A
authors.lastname: Hashimoto
authors.forename: T
authors.initials: T
authors.lastname: Nagumo
authors.forename: S
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D011475:Prosthesis Failure