Cardiogenic shock due to leaflet migration of On-X® aortic mechanical prosthesis.

Cardiogenic shock is a life-threatening condition requiring fast and efficient diagnostic and therapeutic measures. In this case, the history of several cardiac surgeries hindered finding the correct diagnosis initially. Only after indication of ultima ratio cardiac redo operation the underlying cause was found intraoperatively: a defective mechanical valve prosthesis with migration of one of the two leaflets. Strikingly, this happened in a contemporary On-X® prosthesis, only 4 years post-implant. Timely echocardiography is of utmost importance in patients with prosthetic heart valves presenting in heart failure.