Key result
Watchful observation of an embolised prosthetic valve leaflet in the thoracic aorta allowed for 13 years of event-free survival without haemodynamic compromise.
Case Report (n=1)
No
Watchful observation of an embolised prosthetic valve leaflet in the thoracic aorta may be a viable strategy in exceptional cases without hemodynamic compromise where surgical removal poses prohibitive risk.
May support observation in select prohibitive-risk cases; leaves open need for systematic study of embolised leaflets.
We report the case of a patient who underwent a redo surgery for a leaflet escape from a Bjork-Shiley tilting disc mitral prosthesis inserted 18 years previously. The escaped disc remained lodged in the thoracic aorta without any complication. She ultimately died of terminal heart failure 13 years after the second operation. We believe this to be the longest survival with a dislodged leaflet from a mechanical valve. Removal of dislodged disc is recommended in literature but there may be a place for watchful observation in exceptional cases with no haemodynamic compromise.
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Devbhandari et al. (2008) conducted a case report in Embolised prosthetic valve leaflet (n=1). Watchful observation was evaluated on Event-free survival. Watchful observation of an embolised prosthetic valve leaflet in the thoracic aorta allowed for 13 years of event-free survival without haemodynamic compromise.
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