To the Editor.—A 37-year-old man was admitted to the emergency room because of shortness of breath. He was diaphoretic and complained of difficulty and inability to move his legs. A Braunwald-Cutter aortic valve prosthesis had been inserted 45 months previously, probably because of a congenital bicuspid aortic valve. He went into shock, became acutely dyspneic, and died three hours after admission.
At postmorten examination, the heart weighted 550 gm. The fabric covering the aortic prosthesis was worn, and the poppet completely occluded the lower segment of the aorta below the origin of the renal arteries. As determined by the manufacturers of the valve, there was a decrease of 23% in the volume and 20% in the weight of the poppet.
The Braunwald-Cutter valve employing a cloth covering over a metal cage and a Silastic poppet was introduced in 1971. Complications associated with this type of valve include cloth wear,