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      Revisiting echocardiographic features of prosthetic heart valves: the necessity of correct differentiation of mono-leaflet vs. bileaflet mechanical heart valves in a case report


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          Mechanical heart valve replacement is a standard treatment for severe valvular disorders. The use of mono-leaflet valves has decreased recently. Recognizing the echocardiographic features of mono-leaflet and bileaflet valves is crucial for accurate complication diagnosis and proper management.

          Case Presentation

          A 65-year-old female with mono-leaflet mitral and bileaflet tricuspid valves underwent an echocardiographic assessment. This simple educational case provides a unique opportunity to compare the echocardiographic features of these valves within a single patient.


          There is a crucial need for clinicians, particularly those in training, to differentiate between mono-leaflet and bileaflet mechanical heart valves adeptly. With mono-leaflet valves decreasing in prevalence, proficiency in recognizing the echocardiographic nuances of each type is imperative. Failure to do so may result in misdiagnoses and inappropriate management. This underscores the significance of continuous education and vigilance in echocardiographic assessments to ensure optimal patient care.

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          Most cited references19

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          Prosthetic heart valves: selection of the optimal prosthesis and long-term management.

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            Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.

            Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs.
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              Mechanical heart valves: 50 years of evolution.

              The past 50 years have witnessed remarkable progress in the development of safe, hemodynamically favorable mechanical heart valves. Starr-Edwards aortic and mitral ball valves introduced in the mid-1960s, continue to be used successfully worldwide. More than 100,000 Omniscience and Omnicarbon tilting-disc valves have been implanted since 1978 with essentially no mechanical failure; similar results have been obtained with more than 300,000 Hall-Kaster and Medtronic-Hall tilting-disc valves over the past 25 years. Pyrolytic carbon, originally used to encapsulate nuclear fuel rods, has been adapted for the fabrication of discs, leaflets and the housings for more than 2 million mechanical valves. The St. Jude bileaflet valves, totally fabricated from pyrolytic carbon, have remained virtually unchanged in design since their introduction in 1977. More than 1.3 million of these valves have been implanted worldwide with virtually no reported failures of the carbon leaflets or housings. Similarly, pyrolytic carbon bileaflet Carbomedics valves have been implanted in more than 500,000 patients since 1986. Now, 50 years after Dr Gibbon's seminal achievement, patients with debilitating valve disease can have elective valve replacement (mechanical or tissue) with an operative mortality approaching 1% to 2% and a low lifetime complication rate.

                Author and article information

                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central (London )
                4 April 2024
                4 April 2024
                : 19
                : 176
                Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Keshavarz Boulevard, Tehran, Iran
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 6 December 2023
                : 11 March 2024
                Case Report
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                © BioMed Central Ltd., part of Springer Nature 2024

                mechanical heart valves,echocardiography,mono-leaflet,bileaflet,thrombosis,cinefluoroscopy,prosthetic heart valves


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