Prosthetic valve leakage following cardiac valve replacements.

Thirty cases were evaluated in order to study the etiology of prosthetic valvular dehiscence in view of its continued occurrence in a small percentage of cases. The clinical course, management, initial valvular pathology, as well as findings at reoperation and necropsy were the main basis of this study. Factors in the genesis of prosthetic valvular dehiscence in the early and late groups seemed to be distinctly different. Of the 24 patients in the early group, defined as those with evident regurgitation within six months of the operation, in 12 the stitches, which were well tied in, had come loose from the tissue bed. The left ventricular contraction was believed to be the disrupting force in at least six patients with grossly dilated mitral ring. P rosthetic valve leakage following cardiac valve replacements still contributes significantly to morbidity amid mortality in most series reported. Thus Herr and co-workers,' Favalaro and associates ,2 and Beahl and colleagues3 have variously reported significant regurgitation around the pros-thetic valves in 2 percent to 4 percent of their patients. Besides prosthetic valve infection, various factors both in the surgical technique and the nature of the tissue bed had been incriminated in the pathogenesis of paravalvular regurgitation.2'4 As some of these factors were remediable and better understood, one hoped that over the years the incidence of valve leakage would diminish. Having paid due attention to these aspects of the problem, we were disconcerted to find that in our hands the incidence of prosthetic valve leakage has remained unaltered. This is shown in Table 1; the yearly output of valve replacements remains fairly constant. The aim in reviewing the cases of 30 of our patients who developed major prosthetic valve leakage in a series of 612 cases is to elucidate factors in the etiology of and prevention of prosthetic valve disruption. MATERIAL AND METHODS Table 2 shows the age distribution of our patients. Males dominated the series in a ratio of 3.3 to 1. Sixteen of the patients ilad leakage of the aortic prosthetic valve, and 14 that of the niitral valve.