title: Live 3D TEE demonstrates and guides the management of prosthetic mitral valve obstruction.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio 43614, USA.
authors.forename: Mangeet
authors.initials: M
authors.lastname: Chahal
authors.forename: Utpal
authors.initials: U
authors.lastname: Pandya
authors.forename: Satjit
authors.initials: S
authors.lastname: Adlakha
authors.forename: Samer J
authors.initials: SJ
authors.lastname: Khouri
mesh_terms: D000328:Adult; D000401:Aircraft; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization; D003937:Diagnosis, Differential; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008946:Mitral Valve Stenosis / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery*