J Cardiovasc Ultrasound.  2013 Jun;21(2):96-99.

Prosthetic Mitral Valve Leaflet Escape

  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. GRHONG@yuhs.ac
  • 2Department of Chest Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Cardiology Division, Yeungnam University College of Medicine, Daegu, Korea.


Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well.


Cardiac valve prosthesis; Prosthesis failure; Cardiogenic shock

MeSH Terms

Echocardiography, Transesophageal
Heart Failure
Heart Valve Prosthesis
Iliac Artery
Mitral Valve
Prosthesis Failure
Shock, Cardiogenic
United Nations


  • Fig. 1 Chest radiography shows acute pulmonary edema with cardiomegaly.

  • Fig. 2 A: Apical four chamber zoom Doppler: no significant mitral regurgitant jet flow is demonstrated, however, mitral regurgitation is suspected despite poor echo window due to posterior acoustic shadowing and tachycardia. B: Continuous wave Doppler demonstrating pressure gradient across prosthetic mitral valve was elevated (mean diastolic pressure gradient 10 mmHg) without prolongation of pressure half time (54 ms). This finding favors regurgitation rather than obstruction. C: Continuous wave Doppler indicating low peak velocity and rapid decline in velocity in late systole, suggesting acute severe mitral regurgitation.

  • Fig. 3 Edward-Duromedics mitral valve retrieved from the emergent surgery.

  • Fig. 4 Computed tomography locating the missing leaflet of the prosthetic valve in infrarenal abdominal aorta. White arrow indicates the missing leaflet.

  • Fig. 5 The remaining fragment of leaflet in infra renal abdominal artery was removed from placed 2 cm above common iliac artery bifurcation.


1. Deuvaert FE, Devriendt J, Massaut J, Van Nooten G, De Paepe J, Primo G. Leaflet escape of a mitral Duromedics prosthesis. Case report. Acta Chir Belg. 1989; 89:15–18.
2. Klepetko W, Moritz A, Mlczoch J, Schurawitzki H, Domanig E, Wolner E. Leaflet fracture in Edwards-Duromedics bileaflet valves. J Thorac Cardiovasc Surg. 1989; 97:90–94.
3. Alvarez J, Deal CW. Leaflet escape from a Duromedics valve. J Thorac Cardiovasc Surg. 1990; 99:372.
4. Kumar N, Balasundaram S, Rickard M, al Halees Z, Duran CM. Leaflet embolisation from Duromedics valves: a report of two cases. Thorac Cardiovasc Surg. 1991; 39:382–383.
5. Tatou E, Saleh M, Eicher C, Brenot R, David M. Fracture-embolization of duromedics valve prosthesis and microscopic uncommon lesions. Ann Thorac Surg. 2001; 71:1366–1369.
6. Baudet E, Roques X, McBride J, Panès F, Grimaud JP. A 8-year follow-up of the Edwards-Duromedics bileaflet prosthesis. J Cardiovasc Surg (Torino). 1995; 36:437–442.
7. Eichler MJ, Reul HM. Mechanical heart valve cavitation: valve specific parameters. Int J Artif Organs. 2004; 27:855–867.
8. Fragoulis S, Palatianos GM. Fractured prosthetic valve leaflet. Eur J Cardiothorac Surg. 2008; 34:907.
9. Devbhandari MP, Woo EB, Hooper TL. Long-term event-free survival with an embolised prosthetic valve leaflet in the thoracic aorta. J Cardiothorac Surg. 2008; 3:34.
10. Vogel W, Stoll HP, Bay W, Fröhlig G, Schieffer H. Cineradiography for determination of normal and abnormal function in mechanical heart valves. Am J Cardiol. 1993; 71:225–232.
11. Bottio T, Casarotto D, Thiene G, Caprili L, Angelini A, Gerosa G. Leaflet escape in a new bileaflet mechanical valve: TRI technologies. Circulation. 2003; 107:2303–2306.
12. Lee SY, Choi JB. Escape of mechanical valve: a case report. Korean J Thorac Cardiovasc Surg. 2007; 40:63–65.
13. Kim JH, Oh SS, Na CY, Baek MJ, Seo HJ, Kim CW. Leaflet escape of edwards duromedics mechanical heart valve: report of 1 case. Korean J Thorac Cardiovasc Surg. 2004; 37:373–375.
14. Youn YN, Yoo KJ. Valve leaflet escape of edwards duromedics mechanical valve. Korean J Thorac Cardiovasc Surg. 2002; 35:60–63.
Full Text Links
  • JCU
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr