Submit manuscript...
Journal of
eISSN: 2373-4396

Cardiology & Current Research

Correspondence:

Received: January 01, 1970 | Published: ,

Citation: DOI:

Download PDF

Abstract

Paravalvular leakage is not a rare condition among patients with mitral prostheses. Two-dimensional echocardiographic approaches are not sufficient to determine the origin of paravalvular leak that occurs after prosthetic mitral valve replacement. Real-time three-dimensional transesophageal echocardiography provides detailed structural identification of paravalvular leak origin and defect morphology compared to two-dimensional transesophageal echocardiography. Here we present a patient with paravalvular mitral regurgitation from a slit like defect between the mitral anular ring and the prosthetic valve delineated with the utility of 3D full volume and 3D color flow imaging modalities.

Keywords: mitral ring, paravalvular leak, transesophageal, echocardiography

Abbreviations

TEE, Transesophageal echocardiography; 2D, two dimensional; 3D, 3 dimensional

Case report

A 65year-old woman suffering from severe mitral valve regurgitation underwent mitral ring annuloplasty (31 no Saint Jude Medical Rigid Ring). After weaning from cardiopulmonary bypass pump, intraoperative transesophageal echocardiography (TEE) was performed this revealed withstanding severe mitral regurgitation. Therefore a supraannular 28 no bileaflet ATS-AP mechanical mitral valve was implanted over the mitral ring and intraoperative TEE showed normally functioning mitral prosthesis. The surgery was completed without complication. The patient experienced an uneventful postoperative period but was readmitted to hospital with ongoing NYHA Class 2 dyspnea one month after discharge. Transthoraic echocardiogram did not show any pericardial effusion but a moderate mitral regurgitation jet detected by color Doppler imaging (Figure 1A). TEE was performed to depict the origin of the regurgitant jet. Two dimensional (2D) TEE showed a moderate paravalvular leakage with the help of color Doppler imaging (Figure 1B). Subsequently, real-time 3 dimensional (3D) TEE revealed a regurgitates jet arising from a slit like defect between the mitral anular ring and the prosthetic valve with the utility of 3D full-volume and 3D color flow imaging modalities (Figures 2A & 2B).

Figure 1 Transthorasic echocardiogram on apical five chamber view (A) and two dimensional transesophageal echocardiogram (B) showing moderate paravalvular mitral regurgitation by color Doppler imaging.
Figure 2 Full volume real-time three-dimensional transesophageal echocardiography revealing supra annulary implanted mitral mechanical prosthesis on a rigid mitral ring (A) and identification of paravalvular leak origin with the utility of 3D color flow imaging modality (B).

Paravalvular leakage is not a rare condition among patients with mitral prostheses1 but a leakage between a mitral ring and mechanic prosthetic valve has not been reported so far. Real-time 3D TEE provides detailed structural identification of paravalvular leak origin and defect morphology compared to 2D TEE.2–5

Acknowledgements

None.

Conflict of interest

Authors declare that there are no conflicts of interest.

References

Creative Commons Attribution License

© . This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.