Journal of ISSN: 2373-4396JCCR

Cardiology & Current Research
Case Report
Volume 1 Issue 2 - 2014
Delineation of a Paravalvular Leak Origin between a Rigid Mitral Ring and Supra-Annular Implanted Mechanical Mitral Prosthetic Valve
Macit Kalcik1*, Mahmut Yesin1, M Ozan Gursoy1 and Mehmet Ozkan2
1Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Turkey
2Department of Cardiology, Kars Kafkas University, Turkey
Received: June 11, 2014 | Published: June 19, 2014
*Corresponding author: Macit Kalcik, Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Esentepe Mah, Milangaz Caddesi Unluer Sitesi B-Blok, No:22, Kartal/Istanbul, Turkey, Tel: 90-536-4921789; Fax: 90-216-4596321; Email: macitkalcik@yahoo.com
Citation: Kalcik M, Yesin M, Ozan Gursoy M, Ozkan M (2014) Delineation of a Paravalvular Leak Origin between a Rigid Mitral Ring and Supra-Annular Implanted Mechanical Mitral Prosthetic Valve. J Cardiol Curr Res 1(2): 00011. DOI: 10.15406/jccr.2014.01.00011

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 fullvolume 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 65 year-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 regurgitant 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 (Figure 2a & 2b).
Paravalvular leakage is not a rare condition among patients with mitral prostheses [1] 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].
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).

References

  1. Gursoy OM, Astarcıoglu MA, Gokdeniz T, Aykan AC, Bayram Z, et al. (2013) Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective. Anatolian Journal of Cardiology 13(7): 633-640.
  2. Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, et al. (2009) Real-time 3- dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol 53(17): 1543-1547.
  3. Singh P, Manda J, Hsiung MC, Mehta A, Kesanolla SK, et al. (2009) Live/real time three-dimensional transesophageal echocardiographic evaluation of mitral and aortic valve prosthetic paravalvular regurgitation. Echocardiography 26(8): 980-987.
  4. Biner S, Kar S, Siegel RJ, Rafique A, Shiota T (2010) Value of color Doppler three-dimensional transesophageal echocardiography in the percutaneous closure of mitral prosthesis paravalvular leak. Am J Cardiol 105(7): 984-989.
  5. Yildiz M, Duran NE, Gokdeniz T, Kaya H, Ozkan M (2009) The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement. Ars Turk Soc Cardiol 37(6): 371-377.
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