[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

" > It is unusual to have one leaflet working and the heart fail,< " 

my thoughts are that both leaflets were unable to close ... in a vertical
position, due to massive aortic regurge .... subsequent to disturbed rhythm
?? .... may be ... can not be excluded .... . yet .. not jammed in a closed
position  .....
however ... the explanation put forward by Bob is very logic .... 
also .... one can not speculate that the position of the leaflets was not
altered by trials for cannulation in a softish aorta with virtually no
pressure ... 
inexperience with emergency rapid cannulation ...... probably yes ... still
... is that the only factor ?? 

At the end .... 
it is very important to know WHY it happened ... to prevent it later .. 
yet my first issue was to figure out the best first action that should have
been done in such cases.... first ...

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Salerno, Tomas
> Sent: Wednesday, December 13, 2006 6:44 AM
> To: OpenHeart-L at lists.hsforum.com; OpenHeart-L at lists.hsforum.com
> Subject: RE: [HSF] Valve Dysfunction - failure of Closure
> 
> I agree with Don, as this information might be of help, as there are too
many new
> valves out there, and there might be problems with some of them.  It is
unusual to
> have one leaflet working and the heart fail, reason why we published in
the past, a
> case of one leaft of St. Jude stuck in the close position, while the other
functioned
> perfectly and the problems was discovered when routine echo and
fluoroscopy were
> done.
> 
> 
> 
> Tomas
> 
> 
> 
> Nasser,
> This is a very serious event and as far as I gather there is no proof
> that the valve was jammed shut although the clinical presentation
> strongly suggests this.
> When you eventually got to the valve you said one leaflet was open
> and the other was not jammed.
>   Is that correct?
> It would seem to be impossible for a suture or strand of tissue to
> jam both leaflets and it should have been obvious if that was the cause.
> Another strange aspect of this case is the relatively late presentation.
> One would expect an operative mechanical problem like distortion of
> the ring to present early.
> Why would the valve jam while the heart was contracting and un-jam
> when the heart was virtually dead?
> 
> I don't understand your reluctance to tell us the valve type. "
> Sacred brand"  St Jude I expect but which type?
> 
> The reason I am so concerned is that I have been involved in three
> deaths from the  Shiley valve strut failure fiasco and I had a
> difficult time promulgating the danger involved in the use of this
> valve including in having a letter to the Lancet rejected; probably
> industry related.
> 
> The valve company is likely to give you false information about other
> similar incidents if they have occurred or blame you for bad surgical
> technique
> if my experience is anything to go on.
> 
> Hal, can you shed more light on the problem you had with St. Jude
> valves jamming?
> 
> Death from bad valve are inexcusable but also preventable. We all
> have a duty to  be very suspicious of possible valve problems and to
> disseminate such information widely.
> 
> Don
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