Leaflet escape in a revised Edwards-Duromedics mitral prosthesis.

The original Duromedics-Edwards bileaflet valve was withdrawn from the market in 1988 after 12 reports of leaflet escape. The leaflet was modified by the manufacturer, and the revised Edwards-Duromedics and Edwards TEKNA valves were introduced in 1990 and 1993, respectively. However, problems of leaflet escape have now been reported with the new models. A case is reported of sudden leaflet fracture of a revised Duromedics mitral valve 86 months after implantation; this was managed successfully by emergency replacement with a St. Jude Medical mechanical prosthesis. The fracture had occurred transversely, with the two fragments embolizing bilaterally to the right common iliac and left external iliac arteries. In the absence of an exact diagnosis, but with a high index of suspicion, the key to survival of patients with leaflet escape is immediate reoperation.