Indications for Replacement of the Beall 103 and 104 Disc Valves

Because of the unpredictable risk of failure of the Beall 103 and 104 valves, 29 patients who had such a valve implanted between 1969 and 1975 were identified in 1979 and studied to determine clinical status, degree of hemolysis, and valve function by cinefluoroscopy and echocardiography. Seven had valve replacement early after initial study because of cardiac symptoms or severe hemolysis or both. Of the 22 patients followed from January, 1980 to August, 1985, 13 experienced new symptoms or hemolysis, and had valve replacement. Serial observations over a mean of 2.8 years in patients with an isolated Beall valve eventually requiring operation for severe valve wear showed increasing hemolysis frequently concomitant with onset of cardiac symptoms. There were no perioperative deaths in 20 Beall valve replacements, which included 9 multiple valve operations. The mean interval to replacement for all patients was 8.5 years. When the only prosthetic valve was the Beall mitral valve, severe valve wear was associated with higher levels of lactate dehydrogenase (LDH) (1.17 ± 67 IU [ ± standard error]) than those with mild or moderate valve wear at reoperation (LDH, 565 ± 68 IU; p < 0.01). Cinefluoroscopy identified abnormal disc motion in 3 patients, all with clinical deterioration; all patients with disc to cage ratios of 0.90 or less had severe valve wear, but more patients with severe wear had normal ratios. Cardiac catheterization frequently did not show major abnormalities. The onset of new cardiac symptoms or evidence of increasing hemolysis from serial serum LDH determinations or evidence of abnormal disc size or motion by cinefluoroscopy indicate a high probability of severe Beall valve wear. The risk of reoperation is low when done early after severe valve wear becomes evident.