Fracture of the Duromedics mitral valve housing with leaflet escape.

We report a case of leaflet embolisation consequent upon a hemicircumferential fracture of the pyrolytic valve housing of a 29 mm mitral Duromedics Valve implanted for seven months. The clinical presentation is discussed and the literature on mechanical valve failure compared. Unlike pivoting disc valves where absent valve clicks equate with serious occluder dysfunction, valve sounds may persist with bileaflet valve malfunction due to the unimpeded movement of the normally functioning second leaflet. Whilst intrinsic structural failure is increasingly uncommon constant clinical awareness of its occurrence in a patient with a mechanical valve presenting with unexplained acute heart failure and pulmonary oedema, and prompt surgical intervention offers the best chance of survival. The aetiology of the primary fracture in this case remains unclear.