Author + information
- Received June 9, 2009
- Accepted June 18, 2009
- Published online July 27, 2010.
- Justin E. Davies, MBBS, BSc, PhD,
- Beth Unsworth, BSc, RCCP,
- Darrel P. Francis, MB, BChir, MA, MD,
- Roberto Casula, MD and
- Nilesh Sutaria, MD, MBChB
This 55-year-old man presented with increasing shortness of breath over the preceding 2 months. Echocardiography of his prosthetic mitral valve (Starr-Edwards, Edwards Lifesciences, Irvine, California) had been unremarkable over the 13 years since implantation. There was no history of infective endocarditis, all blood cultures and inflammatory markers remained negative throughout. Transthoracic echocardiography now demonstrated new severe mitral regurgitation and suggested the prosthetic valve had become unseated. A 3-dimensional transesophageal echocardiogram was performed, which clearly demonstrated the prosthetic valve had almost totally detached from the sewing ring, was highly mobile, and rocking deeply into and out from the left atrium (A, Online Video 1). In addition, we identified the individual sutures that had dehisced from those that remained attached. An emergency valve replacement was performed. At the time of surgery, the appearance of the valve and sutures was noted to be identical to that of the 3-dimensional transesophageal echocardiogram images (B).
- Received June 9, 2009.
- Accepted June 18, 2009.
- American College of Cardiology Foundation