Expulsion of the disk of a Bjork-Shiley aortic prosthesis after temporary removal.

A 42-year-old woman was diagnosed by cardiac catheterization as having severe mitral stenosis and grade-3/4 aortic regurgitation. The patient underwent mitral commissurotomy and replacement of the aortic valve with a No. 21 Bj#{246}rkShiley tilting-disk prosthesis. The prosthesis was fixed in place with 16 single sutures (Ethiflex). In the immediate postoperative period the clinical picture and the phonocardiogram suggested significant aortic regurgitation. Repeat surgery was performed 13 days after the first procedure. It was discovered that an excessively large space existing between two of the sutures was responsible for the leak. In order to gain better access to this zone, we decided to remove the disk; we also rotated the valve within the sewing ring with the valvular holder designed by the manufacturer for this purpose. The leak was closed with a U suture, the disk was put back into position, and it was left functioning normally, being apparently well held in place, The patient was discharged from the hospital ten days later, without any evidence of aortic regurgitation. Seventeen days after the second operation, the patient was awakened from her sleep by a nightmare, and seconds later she lost consciousness. She was readmitted to our hospital in cardiac arrest. All manipulations to induce recovery failed, and the patient died. The autopsy revealed that the disk had dislodged from the rest of the prosthesis and had come to rest in the abdominal aorta. On examination of the valve, an excessive clearance between the struts and the disk was discovered.