A RARE COMPLICATION OF MITRAL-VALVE REPLACEMENT - SUDDEN CARDIAC DEATH FOR IMMOBILIZATION OF DISC VALVE BY AN UNRAVELED SUTURE

Disc immobilization caused by an unraveled suture in a mitral valve pr osthesis represents a rare extrinsic complication in heart valve repla cement. We report a case of a 54-year-old white male who underwent mit ral valve replacement because of a severe mitral regurgitation. A Bjor k-Shiley tilting disc was implanted with interrupted <<U>> shaped 3/0 silk sutures. There were no complications and the patient was discharg ed in the 10th postoperative day. Twenty days after surgery the patien t died for acute pulmonary edema. Autopsy revealed an unraveled suture producing interference with the tilting disc as a cause of disc prost hesis immobilization in closed position. The possible explication of t his rare complication is the combination between unraveled suture and the pleating held by Teflon sewing ring after restoring heart function . A flaccid heart can produce an overestimation of the annulus size an d the valve ring can bring an anomalous interference with the valve me chanism. In conclusion disc immobilization by an unraveled suture is a complication that can occur very rarely but an accurate prevention mu st be warrant particularly with a tilting disc more than a beleaflet p rosthesis.