MAUDE MDR 9763741

MDR report key
9763741
Report number
MW5093328
Event key
0
Event type
3
Date of event
2020-02-05
Date received
2020-02-26
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Report source
P
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PERCEVAL VALVE MEDIUM 23MMHEART - VALVE, PROSTHESISSORIN GROUP / LIVANOVA USA, INC.DTIICV 1209I R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-02-2601. R

Event Narratives#

D

Patient 1

HEART VALVE EXPLANTED DUE TO DEFECT. "INDICATION FOR PROCEDURE: THIS (B)(6) Y/O GENTLEMAN FIRST UNDERWENT AN AORTIC VALVE REPLACEMENT WITH A TRIFECTA VALVE IN EARLY 2017. IN (B)(6) 2019, HE PRESENTED HERE WITH ENDOCARDITIS OF HIS TRIFECTA VALVE AND UNDERWENT A REDO AORTIC VALVE REPLACEMENT BY THIS SURGEON. A MEDIUM SIZED PERCEVAL VALVE WAS INSERTED. THE PT DID WELL AFTER THIS AND INTRAOPERATIVE ECHO SHOWED THE VALVE TO BE WELL SEATED WITH NO PERIVALVULAR LEAK AND A PRE-DISCHARGE ECHO ALSO SHOWED THAT THE VALVE WAS FUNCTIONING WELL WITH NO PERIVALVULAR LEAK. THE PT DID WELL FOR SEVERAL MONTHS AND AROUND 3 WEEKS AGO DEVELOPED SHORTNESS OF BREATH AND WAS FOUND TO HAVE BILATERAL PULMONARY INFILTRATES. HE WAS WORKED UP BY A PULMONOLOGIST AND AN ECHO WAS DONE SHOWING A SIGNIFICANT PERIVALVULAR LEAK AROUND THE PERCEVAL VALVE. HE WAS ADMITTED TO OUR HOSP AND HE WAS WORKED UP INCLUDING A TRANSESOPHAGEAL ECHO AND A CTA, WHICH DEMONSTRATED THAT THERE WAS A LARGE POSTERIOR PERIVALVULAR LEAK. THE CTA INDICATED THAT A PORTION OF THE VALVE WAS MISSING AND APPEARED TO BE LOCATED IN THE RIGHT COMMON ILIAC ARTERY, WHERE I WAS NOT CAUSING ANY FLOW OBSTRUCTION. THE PT WAS IN MODERATE CONGESTIVE HEART FAILURE, BEING CONTROLLED WITH LASIX. HE HAS HAD PREVIOUS CORONARY ANGIOGRAPHY DEMONSTRATING THAT HE HAS MID-TO-MODERATE CORONARY ARTERY DISEASE WITH NO SIGNIFICANT LESIONS. THE VALVE WAS REMOVED AND A NEW VALVE PLACED. FDA SAFETY REPORT ID# (B)(4).