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Tissue mitral valve prosthesis early failure

Authors: Garbi M, Khwanda A

Princess Royal University Hospital & King’s College Hospital

Contact: Madalina Garbi MD MA FRCP
e-mail: madalina.garbi@nhs.net


 

Description

  • 78 years old lady with history of admission in congestive heart failure just 2 - 3 months post mitral valve replacement with tissue prosthesis of unknown type, and multiple subsequent similar admissions in the year following the procedure
  • Chronic atrial fibrillation
  • Frail, with multiple comorbidities
  • Not keen on invasive investigations and management
  • Referred to the specialised valves clinic as having “residual mitral regurgitation”

Clinical case information

ECHOCARDIOGRAMS PERFORMED DURING HOSPITALISATIONS WITH HEART FAILURE

http://www.youtube.com/watch?v=LvsSzFyrzm0
http://www.youtube.com/watch?v=OUpvvqo500I
Early post mitral valve replacement
http://www.youtube.com/watch?v=skLClA0damM
http://www.youtube.com/watch?v=Ng6TjZDKIaA
Subsequent hospitalisation

3D ECHO PERFORMED IN THE VALVES CLINIC

http://www.youtube.com/watch?v=6BeWSVkYdy4
http://www.youtube.com/watch?v=dYNJExxkI3Y
Severe transvalvular mitral regurgitation

 

http://www.youtube.com/watch?v=SDuONhPcYaU
View from within the LV towards the prosthetic valve reveals incomplete closure of bioprosthetic cusps resulting in eccentric regurgitant orifice

TOE

http://www.youtube.com/watch?v=mIfI10I14uo
Severe transvalvular mitral regurgitation

3D TOE

http://www.youtube.com/watch?v=xCuccTDjj3o
http://www.youtube.com/watch?v=S0KcQRCtfzk
Multi-plane colour flow Doppler: severe mitral regurgitation 3D Colour Flow Doppler: severe MR

 

http://www.youtube.com/watch?v=rrZz6QR7bJY
http://www.youtube.com/watch?v=slB-qZW6JK4
MR jet only View of the bioprosthetic valve from within the left ventricle – reduced excursion particularly of one cusp

 

http://www.youtube.com/watch?v=-iFOmeJISeo
View towards the bioprosthetic valve from within the left atrium (within the valve) - laser line point at the dysfunctional cusp

POST TRANSCATHETER VALVE IN VALVE IMPLANTATION

http://www.youtube.com/watch?v=50RLkH_Np9g
http://www.youtube.com/watch?v=yN9SNF7axbU
No MR

 

3D TTE POST VALVE IN VALVE

http://www.youtube.com/watch?v=F3XPjl91-2k
View from within the left ventricle

Conclusion

Review of echocardiograms performed during the last 2 hospitalisations reveals significant transvalvular mitral regurgitation. 3D transthoracic echo and 3D TOE confirm severe mitral regurgitation due to early dysfunction (failure) of tissue mitral valve prosthesis.
Transcatheter valve in valve implantation resolved the mitral regurgitation and the congestive heart failure symptoms and signs