Late-Onset Mitral Valve Prosthesis Dehiscence With Severe Paravalvular Leak—Infectious Versus Noninfectious Etiology Dilemma: A Case Report

Prosthetic paravalvular leakage stems from imperfect sealing between the prosthetic valve and the surrounding annulus, leading to backward blood flow.While often detected early after surgery, occurrences can emerge years later.We describe a 47-year-old woman, 12 years after aortic and mitral valve replacement, with hemolytic anemia.Echocardiography revealed mitral valve prosthesis dehiscence and severe paravalvular leakage.Although imaging suggested late-stage infectious endocarditis, intraoperative examination ruled it out.Reinforcing prosthesis sutures yielded positive results, underscoring diagnostic challenges and the need for diverse imaging modalities in managing late paravalvular leaks.Mitral paravalvular leak (PVL) is a recognised but rare complication after mitral valve replacement, occurring in about 7% to 17% of cases and being twice as common as with aortic prostheses. 1 It can result from tissue calcification, improper valve sizing, infection, and tissue fragility.Moderate to severe cases more than double the risk of all-cause mortality.1 Consequently, managing mitral PVL necessitates a careful approach, weighing the potential risks of intervention against the benefits of symptom alleviation and complication prevention.What makes the present case unique is the occurrence of a significantly delayed onset of mitral PVL, alongside a discrepancy in etiology between imaging findings and perioperative assessment.This case report aims to clarify mitral PVL complications, highlighting clinical challenges and the need for a multidisciplinary approach for optimal outcomes.