title: Catastrophic mitral prosthesis dehiscence diagnosed by three-dimensional transesophageal echocardiography.
abstract: In emergency situations, real-time three-dimensional transesophageal echocardiography (RT 3-dimensional TEE) may provide unique anatomic insights on prosthetic valves when two-dimensional imaging is inconclusive. We report the case of a 76-year-old woman, in cardiogenic shock, who had undergone mitral valve replacement 3 months ago. RT 3-dimensional TEE revealed almost total, catastrophic prosthesis dehiscence following infective endocarditis, the prosthesis being perpendicular to the normal mitral plane. Corrective surgery was not feasible, and the patient died shortly after admission. Although the outcome was unfortunate, RT 3-dimensional TEE helped rapidly reach a definitive diagnosis, essential for decision-making. Three-dimensional TEE should be used as a complementary technique in difficult cases.
authors.affiliation: University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania.
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Ciobanu
authors.forename: Steven C
authors.initials: SC
authors.lastname: Griffin
authors.forename: Sean
authors.initials: S
authors.lastname: Bennett
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging*; D017809:Fatal Outcome; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: cardiogenic shock; mitral valve prosthesis; prosthesis dehiscence; three-dimensional transesophageal echocardiography