Starr-Edwards Mitral Valve Failure Ten Years After Replacement Surgery: Chronic Fibrous Obstruction of the Prosthesis Frustrum Area

A case of malfunction of a Starr-Edwards caged-ball mitral prosthesis occurring ten years after implantation is presented. The possibility of late malfunction must be suspected in any patient who redevelops symptoms after valve replacement. Preservation of normal prosthetic opening and closing clicks does not prove that the device is functioning normally. The diagnosis is difficult, with cardiac catheterization and demonstration of mitral obstruction providing the most valuable information. Once the diagnosis of prosthesis obstruction is made, reoperation and replacement is mandatory. This clinical pattern will be seen with increasing frequency as patients with artificial valves are followed over longer periods of time.