title: Prosthetic mitral valve obstruction: role of real-time three-dimensional transesophageal echocardiography in diagnosis.
abstract: Acute prosthetic valve thrombosis is a potentially serious complication with an incidence as high as 6% per patient-year for prostheses in the mitral position. Accurate diagnosis of the degree of obstruction and differentiation of pannus versus thrombus is critical in determination of the best mode of therapy. We discuss a case of a patient with multiple comorbidities who presented with mechanical mitral valve obstruction where both transthoracic and two-dimensional transesophageal echocardiography (TEE) were limited in making an accurate diagnosis regarding the mechanism of obstruction. Real-time 3D-TEE (RT-3DTEE) was critical in identifying a partial thrombus on the mechanical valve and guided the choice of thrombolysis as the most appropriate intervention, thus avoiding high-risk surgery in this patient with significant multiple comorbidities.
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Kannan
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Kahroba
authors.initials: K
authors.lastname: Jahan
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Kapildeo
authors.initials: K
authors.lastname: Lotun
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Janardhanan
mesh_terms: D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000000981:diagnostic imaging*