A Rare Case of Post-Mitral Valve Replacement Ventricular Pseudoaneurysm, Bioprosthetic Dehiscence, and Paravalvular Mitral Regurgitation

Figures

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  Figure 1. Transthoracic Echocardiography Transthoracic echocardiography parasternal long-axis view demonstrating bioprosthetic valvular dehiscence (arrow) and paravalvular mitral regurgitation. LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract; PMV = prosthetic mitral valve; RV = right ventricle.

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  Figure 2. 2-Dimensional Transesophageal Echocardiography Transesophageal echocardiography illustrating pseudoaneurysm (star) as the mechanism of the bioprosthetic valvular dysfunction. (A) Midesophageal 5-chamber view. (B) Short-axis view at the level of the aortic valve. Arrow = valvular dehiscence. AOV = aortic valve; RA = right atrium; other abbreviations as in Figure 1.

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  Figure 3. 3-Dimensional Transesophageal Echocardiography Three-dimensional echocardiography from the left atrial perspective depicting paravalvular mitral regurgitation through the anteriorly located dehiscence.

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  Figure 4. Cardiac Magnetic Resonance Imaging Cinematic Sequences Cardiac magnetic resonance steady-state free precession horizontal long-axis view (left) and basal short-axis view (right) of the left ventricular outflow tract exhibiting the spatial relationship between the bioprosthetic valve, left ventricular pseudoaneurysm (star), and left ventricular outflow tract. Arrow = valvular dehiscence. Abbreviations as in Figures 1 and 2

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  Figure 5. Contrast-Enhanced Axial Computed Tomography Contrast-enhanced axial computed tomography imaging validating the orientation between the bioprosthetic valve, left ventricular pseudoaneurysm (star), and left ventricular outflow tract. Abbreviations as in Figures 1 and 2.

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  Figure 6. Contrast-Enhanced Coronal Computed Tomography Contrast-enhanced coronal computed tomography imaging validating the orientation between the bioprosthetic valve, left ventricular pseudoaneurysm (star), and left ventricular outflow tract. Abbreviations as in Figures 1 and 2.

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  Figure 7. 3-Dimensional Computed Tomography Reconstructions Rotated 3-dimensional computed tomography reconstructions demonstrating the spatial relationship between the left ventricular pseudoaneurysm (yellow), stented bioprosthetic mitral valve (white), left atrium (orange), left ventricle (blue), and aorta (red).

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  Figure 8. Surgical Pathology Surgical pathologic examination of the dehisced valve. (A) Ventricular aspect of the bioprosthesis. (B) Atrial aspect of the bioprosthesis.