title: Subannular perforation after long-lasting aortic valve replacement mimicking mitral insufficiency.
abstract: We report a rare case of a patient diagnosed with mitral insufficiency grade III 12 years after mechanical aortic valve replacement. Transesophageal echocardiography described an eccentric mitral regurgitation-type systolic jet with color flow evidence of communication between left ventricle and atrium. Surgical intervention showed a circular defect in the mitral-aortic intervalvular fibrosa area, after removal of the mechanical valve, located beneath the noncoronary sinus causing the echocardiography-detected mitral insufficiency. A pericardial patch was trimmed to the appropriate size, and the defect was closed. The aortic valve was replaced by a stented pericardial bioprosthesis.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany. ju.strauch@gmx.de
authors.forename: Justus T
authors.initials: JT
authors.lastname: Strauch
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Henning
authors.initials: H
authors.lastname: Krep
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D020878:Device Removal; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D006085:Graft Survival; D006341:Heart Rupture / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D011475:Prosthesis Failure; D012086:Reoperation; D018570:Risk Assessment; D016378:Tissue Transplantation / Q000379:methods; D016896:Treatment Outcome