Eur J Cardiothorac Surg 2006;29:106
© 2006 Elsevier Science NL
Images in cardio-thoracic surgery |
Bioprosthetic leaflet perforation due to repetitive trauma by overknotted sutures
Antonio García-Valentín,
Manuel Castellá
*
,
Miguel Josa,
Jaume Mulet
Department of Cardiovascular Surgery, Hospital Clínic, University of Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain
Received 14 September 2005;
accepted 17 October 2005.
* Corresponding author. Tel.: +34 93 22755 15; fax: +34 93 2275749. (Email: mcaste{at}clinic.ub.es).
Key Words: Cardiac surgery • Valves • Reoperation
Five years after aortic intra-annular valve replacement using a Carpentier–Edwards Perimount bioprosthesis, a 72-year-old man was reoperated due to progressive aortic regurgitation. At surgery, several prosthetic tissue disruptions were discovered. Both our and Edwards Lifesciences laboratories agreed these perforations were caused by continuous trauma of the leaflets against the overknotted sutures (Figs. 1 and 2
).
View larger version (108K):
[in this window]
[in a new window]
|
Fig. 1. As the malfunctioning bioprosthesis was explanted, no evidence of tissue deterioration or calcification was evident in either pericardial leaflets after five years.
|
|
View larger version (78K):
[in this window]
[in a new window]
|
Fig. 2. Four lesions in the right and non-coronary cusps were detected, two being complete tissue tears (A and B). The macroscopic, microscopic and radiological studies were compatible with prosthetic dysfunction due to repeated abrasion of the leaflets against the suture material during systolic movement. This mechanism was suggested because the tissular erosions matched with the knots of the interrupted 2/0 Tycron sutures used to implant the prosthesis through the sewing cuff. At some suture ends, up to seven to eight knots were roughly counted. Note the big perforating abrasion (B) matching the white knotted suture (slightly out of focus).
|
|
