ST. JUDE MEDICAL PROSTHETIC VALVE WITH A STUCK LEAFLET IN THE TRICUSPID POSITION WITH EVENTFREE SURVIVAL FOR TEN YEARS

Abstract

The patient was a 52 year-old female who had undergone mitral valve replacement and tricuspid valve replacement with St. Jude Medical prostheses ten years earlier. Three months after surgery, the tricuspid prosthetic valve was found to be stuck in one leaflet. Cineradiography revealed that the prosthetic valve in the tricuspid position was implanted with the hinges oriented vertically to the interventricular septum and the anterior leaflet was fixed in a closed position. Echocardiogram showed no right ventricular dilatation and trivial tricuspid prosthetic valve regurgitation with a valvular area of 2.5cm². The patient has recieved anticoagulation therapy using Coumadin in an attempt to control thrombotest between 8 and 10% to prevent prosthetic valve thrombosis. The patient has been free from symptoms without apparent cardiac failure for the last ten years and has been followed by periodic cineradiography. The causes of the stuck valve are unclear, but may be attributed to an improper placement of the prosthetic valve, insufficient anticoagulation therapy or an inappropriately large prosthetic valve.