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Thrombosed prosthetic mitral valve
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  1. Komarakshi Balakrishnan1,
  2. Sanjeev Aggarwal2,
  3. Gautam Balakrishnan3
  1. 1Cardiothoracic Surgery Department, Fortis Malar Hospital, Chennai, India
  2. 2Cardiology Department, Fortis Malar Hospital, Chennai, India
  3. 3Internal Medicine Department, Fortis Malar Hospital, Chennai, India
  1. Correspondence to Dr Komarakshi Balakrishnan, krbalakrishnan{at}vsnl.com

https://doi.org/10.1136/bcr.10.2011.5002

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    Description

    A 29-year-old woman presented with pulmonary oedema and low cardiac output. Her mitral valve was replaced 20 years back with a Sorin mechanical valve. She had stopped anticoagulants a month back on her own for excessive menstrual bleeding. Echo showed a gradient of 26 mm Hg across the valve with regurgitation. Fluroscopy confirmed limited disc opening of only 15° with incomplete disc closure (figures 1 and 2) (videos 1 and 2). She was reoperated using a St Jude mechanical valve. The excised prosthetic valve showed thrombus and pannus almost completely occluding the disc and severely restricting disc mobility (figures 3 and 4).

    Figure 1
    Figure 1

    The incomplete closure of the valve disc during systole is evident.

    Figure 2
    Figure 2

    Disc position in diastole. The disc opening is limited, with an ‘opening angle’ of barely 15° resulting in severe prosthetic stenosis.

    Figure 3
    Figure 3

    The prosthesis, viewed from the atrial side is almost completely occluded by thrombus and pannus.

    Figure 4
    Figure 4

    Seen from the ventricular side, the disc is clearly entrapped preventing it from closing completely. This is clearly seen in the fluoroscopy and is the reason for the mitral incompetence.

    Video 1

    The minimal opening and incomplete closure of the disc are obvious.

    Video 2

    Enface view showing minimal disc excursion.

    Acknowledgments

    The authors wish to acknowledge Drs Suresh Rao, NK Kapadia, SK Chowdhry and Vijit Cherian for contributing to the clinical care of this patient.

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    Footnotes

    • Competing interests None.

    • Patient consent Not obtained.