Occasional single beat regurgitation observed with the medtronic advantage bileaflet heart valve.
BACKGROUND
The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institution, 63 patients received the Advantage bileaflet mechanical heart valve (Medtronic, Minneapolis, Minnesota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients.


METHODS
Fluoroscopy of leaflet motion (n = 4), invasive blood pressure measurements in the ascending aorta (n = 3) and digital phonocardiography (n = 5) was obtained in the patients showing an intermittent regurgitation during echocardiography.


RESULTS
Valve thrombosis, sutures, or pannus ingrowth impairing valve closure was not detected. Fluoroscopy of leaflet motion showed intermittent incomplete closure of either one of the two leaflets in the same prosthesis. This could be correlated with a distinct diastolic blood pressure drop in the same cardiac cycle. Digital phonocardiography showed pathologic closure sounds in those cycles in which echocardiographically the intermittent regurgitation was observed.


CONCLUSIONS
Some patients with the Medtronic Advantage prosthesis in the aortic position show an intermittent inability of complete valve closure that leads to a single beat transvalvular regurgitation. As thrombotic or other material that might cause a disturbance of leaflet motion could not be detected, and the patients seem not to be exposed to any risk except for some chronic regurgitant volume, we decided not to replace the prostheses.
Eichinger
Walter B
WB
Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. eichinger@dhm.mhn.de
Wagner
Ina M
IM
Bleiziffer
Sabine
S
von Canal
Friederike
F
Günzinger
Ralf
R
Ruzicka
Daniel J
DJ
Busch
Ulrich
U
Bauernschmitt
Robert
R
Lange
Ruediger
R
D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D001795:Blood Pressure Determination; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D010701:Phonocardiography; D011446:Prospective Studies; D014463:Ultrasonography