title: Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization.
abstract: BACKGROUND
  Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models.
  
  
  METHODS
  A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn't specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy.
  
  
  RESULTS
  After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery.
  
  
  CONCLUSIONS
  The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Eyup Serhat
authors.initials: ES
authors.lastname: Calik
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Husnu Kamil
authors.initials: HK
authors.lastname: Limandal
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Umit
authors.initials: U
authors.lastname: Arslan
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tort
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Yildiz
authors.affiliation: Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey.
authors.forename: Ednan
authors.initials: E
authors.lastname: Bayram
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Dag
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Kaygin
authors.affiliation: Cardiovascular Surgery Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Erkut
mesh_terms: D000328:Adult; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005548:Foreign-Body Migration / Q000150:complications / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011475:Prosthesis Failure; D012770:Shock, Cardiogenic / Q000209:etiology