title: Occasional single beat regurgitation observed with the medtronic advantage bileaflet heart valve.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. eichinger@dhm.mhn.de
authors.forename: Walter B
authors.initials: WB
authors.lastname: Eichinger
authors.forename: Ina M
authors.initials: IM
authors.lastname: Wagner
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Friederike
authors.initials: F
authors.lastname: von Canal
authors.forename: Ralf
authors.initials: R
authors.lastname: Günzinger
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ruzicka
authors.forename: Ulrich
authors.initials: U
authors.lastname: Busch
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
mesh_terms: 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