title: Beware of the B(e)all valve: mistaken valve identity, 30-year survival, and valve replacement.
abstract: Effective management of patients after the implantation of mechanical cardiac valves includes correct recognition of each valve and its related complications. Herein, we present the case of a patient who had undergone implantation of a floating-disc Beall-Surgitool mitral valve in 1976 and developed multiple valve-related complications. Over 30 years and in multiple medical centers, the device was mistakenly assumed to be a "ball" valve. The correct identification of the prosthesis led to the recognition of valvular failure, and the patient underwent its replacement with an On-X bileaflet carbon valve. Pathologic and microscopic examination of the explanted Beall valve showed massive pannus formation that extended over the sewing cuff on the atrial and ventricular side, preventing complete disc closure; disrupted fabric coating of the sewing ring, with exposure of the underlying metal; and a marked inflammatory reaction. We report one of the longest intervals on record between the implantation and replacement of a Beall-Surgitool valve.
authors.affiliation: Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia 23249, USA. On.Topaz@va.gov
authors.forename: On
authors.initials: O
authors.lastname: Topaz
authors.forename: Molly S
authors.initials: MS
authors.lastname: Rutherford
authors.forename: Shannon
authors.initials: S
authors.lastname: Mackey-Bojack
authors.forename: Pritam R
authors.initials: PR
authors.lastname: Polkampally
authors.forename: Allyne
authors.initials: A
authors.lastname: Topaz
authors.forename: Andreas
authors.initials: A
authors.lastname: Prinz
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Szentpetery
mesh_terms: D000328:Adult; D020878:Device Removal; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
references.citation: Circulation. 1969 May;39(5 Suppl 1):I141-7
references.pmid: 5792967
references.citation: J Thorac Cardiovasc Surg. 1980 Jul;80(1):45-9
references.pmid: 7382534
references.citation: Ann Thorac Surg. 2003 Dec;76(6):S2230-9
references.pmid: 14667692
references.citation: Chest. 1983 Apr;83(4):632-7
references.pmid: 6831952
references.citation: J Am Coll Cardiol. 2006 Nov 21;48(10):2156-7
references.pmid: 17113006
references.citation: Tex Heart Inst J. 2008;35(4):385-7
references.pmid: 19156229
references.citation: Z Kardiol. 1986 Nov;75(11):688-90
references.pmid: 3544550
references.citation: Arch Mal Coeur Vaiss. 1978 Aug;71(8):944-8
references.pmid: 101172
references.citation: Circulation. 1978 Mar;57(3):613-23
references.pmid: 624173
references.citation: Circulation. 1977 Oct;56(4 Pt 1):617-22
references.pmid: 143353