Fatal leaflet escape in an Edwards TEKNA aortic prosthesis.
The case is reported of a 26-year-old male patient who died eight years after the replacement of an aortic valve with a bileaflet mechanical valve (TEKNA; Edwards, USA). Following prosthesis implantation, the patient had been in a good state of health, and his death occurred unexpectedly. Forensic autopsy revealed a leaflet escape, with two fragments of the leaflet being found bilaterally in the common iliac arteries. Death occurred due to an acute cardiac insufficiency. Immunohistochemical investigations revealed fresh myocardial fiber necroses. Stereomicroscopic and scanning electron microscopic investigations demonstrated surface erosions of the leaflet. Although the valve was withdrawn from the market in June 2000, it had previously been implanted in over 18,000 patients. Thus, from a clinical viewpoint, the question of using a prophylactic replacement in affected patients must be discussed.
Institute of Legal Medicine, University Hospital Münster, Münster, Germany. pfeiffh@uni-muenster.de
Heidi
H
Pfeiffer
Julia
J
Bertolini
Hans Heinrich
HH
Scheld
Bernd
B
Brinkmann
D000328:Adult; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000601:surgery*; D001344:Autopsy; D004617:Embolism / Q000209:etiology; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000150:complications* / Q000209:etiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D009206:Myocardium / Q000473:pathology; D009336:Necrosis / Q000209:etiology; D011475:Prosthesis Failure