The Annals of Thoracic Surgery, Vol 42, 315-320, Copyright © 1986 by The Society of Thoracic Surgeons
Indications for replacement of the Beall 103 and 104 disc valves
VR Conti, A Nishimura, TR Coughlin and RW Farrell
Because of the unpredictable risk of failure of the Beall 103 and 104
valves, 29 patients who had such a valve implanted between 1969 and 1975
were identified in 1979 and studied to determine clinical status, degree of
hemolysis, and valve function by cinefluoroscopy and echocardiography.
Seven had valve replacement early after initial study because of cardiac
symptoms or severe hemolysis or both. Of the 22 patients followed from
January, 1980 to August, 1985, 13 experienced new symptoms or hemolysis,
and had valve replacement. Serial observations over a mean of 2.8 years in
patients with an isolated Beall valve eventually requiring operation for
severe valve wear showed increasing hemolysis frequently concomitant with
onset of cardiac symptoms. There were no perioperative deaths in 20 Beall
valve replacements, which included 9 multiple valve operations. The mean
interval to replacement for all patients was 8.5 years. When the only
prosthetic valve was the Beall mitral valve, severe valve wear was
associated with higher levels of lactate dehydrogenase (LDH) (1,117 +/- 67
IU [+/- standard error]) than those with mild or moderate valve wear at
reoperation (LDH, 565 +/- 68 IU; p less than 0.01). Cinefluoroscopy
identified abnormal disc motion in 3 patients, all with clinical
deterioration; all patients with disc to cage ratios of 0.90 or less had
severe valve wear, but more patients with severe wear had normal ratios.
Cardiac catheterization frequently did not show major abnormalities. The
onset of new cardiac symptoms or evidence of increasing hemolysis from
serial serum LDH determinations or evidence of abnormal disc size or motion
by cinefluoroscopy indicate a high probability of severe Beall valve
wear.(ABSTRACT TRUNCATED AT 250 WORDS)
