Key result
3D TEE identifies a subaortic curtain perforation causing severe regurgitation missed on 2D TEE.
Why the study?
Severe mitral regurgitation due to perforation of the mitral-aortic intervalvular fibrosa after aortic valve replacement can be difficult to diagnose with standard imaging techniques.
Case Report (n=1)
This case highlights the added value of 3D TEE over 2D echocardiography in identifying complex mechanisms of mitral regurgitation, such as subaortic curtain perforation.
May improve identification of missed subaortic perforations in select cases; leaves open impact on management and outcomes.
We report the case of a 91-year-old man with severe symptomatic mitral regurgitation (MR), referred for assessment of percutaneous edge-to-edge repair 3 years after bioprosthetic aortic valve replacement (AVR). Detailed transthoracic, trans-oesophageal (TEE), and three-dimensional (3D) echocardiography showed a perforation in the subaortic curtain leading to severe regurgitation from the left ventricular outflow tract to the left atrium, which was undiagnosed on previous two-dimensional echocardiography. This regurgitation might be iatrogenic in origin after AVR in the absence of previous known endocarditis. This case highlights the utility and added value of 3D TEE in identifying the mechanism of MR.
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GORSELEN et al. (2011) conducted a case report in Severe symptomatic mitral regurgitation (n=1). Three-dimensional trans-oesophageal echocardiography vs. Two-dimensional echocardiography was evaluated on Identification of the mechanism of mitral regurgitation. Three-dimensional trans-oesophageal echocardiography identified a subaortic curtain perforation causing severe regurgitation that was missed on previous two-dimensional echocardiography.
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