[A case of acute extrinsic malfunction of prosthetic valve due to suture tag causing incomplete closure of the disc].

A 56-year-old woman who had suffered from both aortic and mitral valve stenosis and regurgitation was treated by replacement of valves with 23 mm and 27 mm Björk-Shiley valves respectively. After weaning from cardiopulmonary bypass, the arterial systolic pressure rose to 100 mmHg but the diastolic pressure fell to 40 to 50 mmHg. Studies including transesophageal echocardiogram and fluoroscopy during operation revealed the valves functioning normally. Because low diastolic pressure and low cardiac output continued during postoperative period, fluoroscopy was carried out again. It showed incomplete diastolic closure of the disc of the prosthetic aortic valve. The emergency operation was performed. At reoperation, it was found that one of the end of suture knots located between the valve ring and the disc prevented the occluder from seating completely and caused aortic regurgitation. The suture end was cut shorter and the prosthesis within the sewing ring was rotated so that the occluder was kept away from the suture end.