[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

">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.< "

I have met an exact case like that ..... yet the patient is refusing a
re-replacement operation. initially a candidate of double valve replacement,
Mitral and Aorta, re-replaced after a year for prosthetic endocarditis. went
well thereafter for 4 years ... complained of some shortness of breath and
fatigue on Ex. Echo showed one leaflet of the aortic prosthesis -same brand-
functioning well ..... second one was dysfunctional on and off ....... hangs
in the mid-position ... 
he is still alive .... managed medically with ACEIs and CCBs ..... degree of
regurgitation reduced "2/4" .... yet he is refusing an operation ..... still
being followed up for 5 years now ... 


NFA

> From: Salerno, Tomas
> 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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