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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



  • 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

Early post mitral valve replacement
Early postop plax
Early postop 4ch


Subsequent hospitalisation
Early sever mr plax
Early sever 4ch


3D Echo performed in the valves clinic

Severe transvalvular mitral regurgitation
Early dysf 3D TTE LV view
Early dysf 3D TTE colour


View from within the LV towards the prosthetic valve reveals incomplete closure of bioprosthetic cusps resulting in eccentric regurgitant orifice
Early dysf 3D TTE LV view only



Early postop 4ch



Multi-plane colour flow Doppler: severe mitral regurgitation
Multi-plane colour flow Doppler: severe mitral regurgitation


MR jet only
View of the bioprosthetic valve from within the left ventricle – reduced excursion particularly of one cusp


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

Plax valve in valve
4ch valve in valve


3D TTE post valve in valve

View from within the left ventricle



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