Key result
On-X mechanical mitral valve leaflet fracture and escape causes severe MR in a 12-year-old boy.
Why the study?
Leaflet fracture and escape is a rare but serious complication of mechanical heart valves, with no prior reports involving an On-X mechanical mitral valve in a child.
Case Report (n=1)
This case highlights a rare but severe complication of leaflet fracture and escape from an On-X mechanical mitral valve in a pediatric patient, emphasizing the role of transoesophageal echocardiography in diagnosis.
Answers are grounded in this paper and cite their sources.
Prompts vigilance for leaflet escape in children with On-X mitral valves and acute decompensation; extends reported mechanical valve complications to this population.
Background Leaflet escape is a rare complication of mechanical heart valves. The following case is the first report of leaflet escape from an On-X mechanical mitral valve in a child. Case summary A 12-year-old boy presented with acute pulmonary oedema one year after mitral valve replacement with an On-X valve for rheumatic heart disease. Transoesophageal echocardiogram diagnosed an absent mechanical mitral valve leaflet and severe mitral regurgitation for which the patient successfully underwent urgent mitral valve replacement. Computed tomography located fragments of the embolised mitral valve leaflet at the bifurcation of the abdominal aorta and within the right common iliac artery. In the absence of impaired lower limb perfusion, the leaflet fragments were left in situ. He was discharged without complication and remains asymptomatic three months post-discharge. Discussion Leaflet fracture and escape is a known but rare complication of mechanical valve prostheses. The first-line investigation for suspected mechanical valve dysfunction is transoesophageal echocardiogram which elicited the diagnosis on this occasion.
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Uthayakumaran et al. (2022) conducted a case report in Rheumatic heart disease with mechanical mitral valve replacement (n=1). On-X mechanical mitral valve was evaluated on Leaflet fracture and escape. A 12-year-old boy experienced leaflet fracture and escape from an On-X mechanical mitral valve one year post-replacement, presenting with acute pulmonary oedema and severe mitral regurgitation.
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