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Ann Thorac Surg 2006;82:537-541
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Occasional Single Beat Regurgitation Observed with the Medtronic Advantage Bileaflet Heart Valve

^a Department of Cardiovascular Surgery, German Heart Center, Munich, Germany
^b Department of Anesthesiology, German Heart Center, Munich, Germany
^c Kardiologische Gemeinschaftspraxis, Munich, Germany

Accepted for publication March 10, 2006.

^_* Address correspondence to Dr Eichinger, Department of Cardiovascular Surgery, Lazarettstr 36, Munich 80636, Germany (Email: eichinger{at}dhm.mhn.de).

BACKGROUND: The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institution, 63 patients received the Advantage bileaflet mechanical heart valve (Medtronic, Minneapolis, Minnesota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients.

METHODS: Fluoroscopy of leaflet motion (n = 4), invasive blood pressure measurements in the ascending aorta (n = 3) and digital phonocardiography (n = 5) was obtained in the patients showing an intermittent regurgitation during echocardiography.

RESULTS: Valve thrombosis, sutures, or pannus ingrowth impairing valve closure was not detected. Fluoroscopy of leaflet motion showed intermittent incomplete closure of either one of the two leaflets in the same prosthesis. This could be correlated with a distinct diastolic blood pressure drop in the same cardiac cycle. Digital phonocardiography showed pathologic closure sounds in those cycles in which echocardiographically the intermittent regurgitation was observed.

CONCLUSIONS: Some patients with the Medtronic Advantage prosthesis in the aortic position show an intermittent inability of complete valve closure that leads to a single beat transvalvular regurgitation. As thrombotic or other material that might cause a disturbance of leaflet motion could not be detected, and the patients seem not to be exposed to any risk except for some chronic regurgitant volume, we decided not to replace the prostheses.

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				L. Hansen, M. Danne, B. Hoffmann, and F.-C. Riess Structural valve failure with every beat regurgitation observed using the Medtronic Advantage aortic valve. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1344 - 1345. [Full Text] [PDF]

				R. W. Emery, G. V. Raikar, and A. M. Emery Invited commentary Ann. Thorac. Surg., August 1, 2006; 82(2): 541 - 541. [Full Text] [PDF]