Causes and treatment strategies of unilateral leaflet shedding of bileaflet mechanical prosthetic heart valves after surgery

Abstract Objective: Unilateral leaflet shedding is a rare complication. This paper discusses the causes and treatment strategies of unilateral leaflet shedding of bileaflet mechanical prosthetic heart valves after surgery. Methods: This study was a retrospective study that included 1 case of unilateral leaflet shedding after mechanical valve replacement of the aortic valve in Fuwai Hospital in 2010 and 1 case of unilateral leaflet shedding after mechanical valve replacement of the mitral valve in the First People’s Hospital of Guangyuan in 2021. The new mechanical valves were replaced during subsequent surgeries. data were collected, and the patients were followed up for 10 years and 3 months after the operations, respectively. Results: The patient with an aortic valve replacement was a male; the patient with a mitral valve replacement was a female; and they had an average STS risk score of 3.9%. Both patients had severe regurgitation, and the results of the reoperations were satisfactory. After the operations, the echocardiograms showed that there was no regurgitation in either of the valve replacements. There were no changes in the ankle-brachial index (ABI) before and after the operation in either of the two patients, and no complications or deaths occurred during follow-up. Conclusion: The reason for the leaflet sheddings may be related to the valve design and the leaflet materia. If the detached leaflets are damaged and if the distal blood vessels are affected, simultaneous surgical treatment is required. Those patients whose vessels were not damaged by the valve lobe should be carefully monitored.