title: Obstruction of St Jude Medical valves in the aortic position: significance of a combination of cineradiography and echocardiography.
abstract: BACKGROUND
  Obstruction of the St Jude Medical valve (St Jude Medical, Inc, St Paul, Minn) is a rare but serious complication.
  
  
  METHODS
  Cineradiographic and echocardiographic evaluations of aortic St Jude Medical valves were simultaneously performed on 54 patients, with no signs of prosthetic valve dysfunction late after surgery.
  
  
  RESULTS
  Although closing angles of the leaflets corresponded closely with the manufacturer data, restricted opening of the leaflets (opening angle >/= 20 degrees ) was found in 16 (group D) of the 54 patients by means of cineradiography. The opening angles were equal to or less than 14 degrees in the other 23 patients (group N) and between 15 degrees and 19 degrees in the remaining 15 (group M). Doppler-derived transprosthetic pressure gradients were significantly higher (P =.03) and the velocity index was significantly lower (P =.003) in group D than in group N. However, no significant differences were found in those values between group N and group M. Replacement of the aortic St Jude Medical valves was performed in 5 of the 16 patients, and the remaining 11 have been followed up because of relatively low pressure gradients. The cause of restricted leaflet movement was pannus formation without thrombosis in 4 patients and valve thrombosis with pannus formation in one.
  
  
  CONCLUSIONS
  Reduced valve orifice area and restricted opening of the leaflets resulting from excess growth of pannus probably led to obstruction of the aortic St Jude Medical valves. A combination of cineradiography and echocardiography makes it possible to provide an accurate and detailed diagnosis of obstruction of the valve.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Kurume, Japan. aoyagi@med.kurume-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Aoyagi
authors.forename: M
authors.initials: M
authors.lastname: Nishimi
authors.forename: H
authors.initials: H
authors.lastname: Kawano
authors.forename: E
authors.initials: E
authors.lastname: Tayama
authors.forename: S
authors.initials: S
authors.lastname: Fukunaga
authors.forename: N
authors.initials: N
authors.lastname: Hayashida
authors.forename: H
authors.initials: H
authors.lastname: Akashi
authors.forename: T
authors.initials: T
authors.lastname: Kawara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve; D002933:Cineradiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014463:Ultrasonography