Transesophageal echocardiographic imaging of multiple complications following mitral valve replacement

Echo Research and Practice
Charles L BrassardPierre Couture

Abstract

We present a case of mitral valve (MV) replacement that resulted in multiple complications, as diagnosed by transesophageal echocardiography (TEE), including left ventricular outflow tract obstruction, aortic dissection and left ventricular rupture. We also describe that identification of bleeding originating from the posterior aspect of the heart by the surgical team should trigger a complete TEE evaluation for adequate diagnosis. An 84-year-old woman underwent a MV replacement. Weaning from cardiopulmonary bypass (CPB) revealed a late-peaking gradient of 44 mmHg over the left ventricular outflow tract caused by obstruction from a bioprosthetic strut. After proper surgical correction, TEE evaluation showed a type A aortic dissection that was subsequently repaired. After separation from CPB, the surgical team identified a major bleed that originated from the posterior aspect of the heart. Although the initial suspicion was injury to the atrioventricular groove, a complete TEE evaluation confirmed a left ventricular free wall rupture by showing the dissecting jet using colour-flow Doppler. TEE is an essential component in cardiac surgery for assessment of surgical repair and potential complications. Posterior bleeding should tri...Continue Reading

References

Sep 2, 1998·The Annals of Thoracic Surgery·N C PoirierJ C Tardif
Nov 5, 2002·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·G W RietmanP W Boonstra
Jul 26, 2006·The Annals of Thoracic Surgery·Kazuma OkamotoYasuhiro Umezu
Apr 16, 2009·General Thoracic and Cardiovascular Surgery·Hirofumi KasaharaWerner Mohl

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