title: Left ventricular outflow tract obstruction by a bioprosthetic mitral valve: diagnosis by cardiac computed tomography.
abstract: Echocardiography has long been the mainstay of noninvasive cardiac diagnostic imaging; however, newer imaging modalities have proven useful in cases where echocardiography has been nondiagnostic. We present a case of a 42-year-old woman with hypertrophic obstructive cardiomyopathy, who despite septal myectomy and bioprosthetic mitral valve replacement, continued to have persistent symptoms of left ventricular outflow tract obstruction. Transthoracic echocardiographic evaluation did not demonstrate the etiology of the patient's symptoms. The cause of our patient's symptoms was clarified using cardiac computed tomography, which revealed a strut from the bioprosthetic mitral valve protruding into the left ventricular outflow tract. Although this clinical phenomenon has previously been described, we will discuss the role of cardiac imaging with computed tomography in this setting.
authors.affiliation: Department of Internal Medicine, St Boniface Research Centre, Manitoba, Canada.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Ducas
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.forename: Shelley R
authors.initials: SR
authors.lastname: Zieroth
authors.forename: Iain D
authors.initials: ID
authors.lastname: Kirkpatrick
authors.forename: Darren H
authors.initials: DH
authors.lastname: Freed
mesh_terms: D000328:Adult; D001705:Bioprosthesis / Q000009:adverse effects*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology*
chemical_list: D003287:Contrast Media