Key result
Live 3D TEE identifies prosthetic mitral valve obstruction and LAA thrombi to guide surgical management.
Case Report (n=1)
Live 3D TEE is a valuable imaging modality for accurately diagnosing prosthetic mitral valve obstruction and guiding subsequent surgical management.
May guide selected prosthetic valve cases; hypothesis-generating and should not change practice without prospective validation.
A 43-year-old woman, with a remote history of rheumatic mitral stenosis and a St. Jude prosthetic mitral valve replacement, presented with shortness of breath and palpitations, shortly after a long flight. On admission, atrial fibrillation with a rapid ventricular response was noted in the setting of a long history of noncompliance with her anticoagulation. Transesophageal echocardiography (TEE) demonstrated multiple laminated thrombi in the left atrial appendage. Live three-dimensional (3D) TEE confirmed this diagnosis and demonstrated an immobile posterior leaflet of the mitral prosthesis, which had direct implications in her management. She successfully underwent surgery for mitral valve replacement, left atrial appendage ligation, and a Maze procedure on the following day. The multiple thrombi within the atrial appendage were confirmed intraoperatively and pannus formation was determined to be the etiology of the leaflet immobility.
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Chahal et al. (2011) conducted a case report in Prosthetic mitral valve obstruction and left atrial appendage thrombi (n=1). Live 3D TEE was evaluated. Live 3D TEE successfully identified an immobile posterior leaflet of a mitral prosthesis and left atrial appendage thrombi, directly guiding surgical management in a 43-year-old woman.
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