RESUMO
A 52-year-old male patient, who underwent mitral replacement with a mechanical prosthesis as a child, sustained a cardiac arrest which was successfully resuscitated. Further investigation showed prosthesis malfunction with significant regurgitation in the context of multi-organ failure. In such a life-threatening condition, veno-arterial extracorporeal membrane oxygenation was considered as a rescue procedure to achieve optimisation of clinical status to allow definitive surgical treatment. An unusual complete fracture of the prosthesis was subsequently identified as the cause of acute dysfunction.
RESUMO
A patient who underwent previous implantation of a mitral valve replacement with a Björk-Shiley Delrin (BSD) mitral valve prosthesis during infancy was admitted to our institution 43 years later after an episode of syncope and cardiac arrest. Under extreme hemodynamic instability, a mitral valve prosthetic dysfunction causing massive mitral regurgitation was identified. The patient underwent an emergent cardiac operation, and a complete disc fracture with partial disc migration was found. Exceptional cases of mechanical prosthetic heart valve fracture exist. We report the first case of complete transversal disc rupture of a BSD mitral valve prosthesis after the longest period of implantation ever reported in that position.
Assuntos
Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Desenho de Prótese/métodos , Falha de Prótese , Ecocardiografia Transesofagiana/métodos , Tratamento de Emergência/métodos , Oxigenação por Membrana Extracorpórea , Seguimentos , Comunicação Interatrial/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/anormalidades , Reoperação/métodos , Resinas Sintéticas , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
A patient was submitted to mitral valve replacement and tricuspid ring annuloplasty. During immediate postoperative course, signs of inferior myocardial ischemia appeared. Acute entrapment of the right coronary artery due to tricuspid ring sutures was confirmed by coronary angiography. The patient was reoperated and a right coronary bypass graft was successfully performed. Tricuspid procedures have shown to be effective and secure with a low rate of complication. Few cases of right coronary artery occlusion have been described and the majority not treated. Exceptional cases of right coronary occlusion related to tricuspid ring annuloplasty have been reported with a favorable outcome, as the case described herein.
