Author + information
- Received November 13, 2013
- Accepted November 26, 2013
- Published online May 13, 2014.
- Silvio Quick, MD,
- Uwe Speiser, MD,
- Ruth H. Strasser, MD, PhD and
- Karim Ibrahim, MD
A 74-year-old man was admitted to our department with a 2-week history of increasing shortness of breath. A transesophageal echocardiography (TOE) revealed a symptomatic and severe mitral valve stenosis with unusual valve leaflet thickening (arrows, mid-TOE 2 chamber view of the prosthetic mitral valve in systole [A] and diastole [B], 3-dimensional TOE in diastole [C], Online Videos 1 and 2). Three months prior he had undergone a transcatheter mitral valve-in-valve implantation with an Edwards SAPIEN XT 29 mm valve (Edwards Lifesciences Corporation, Irvine, California) and was discharged on a dual antiplatelet therapy. The main differential diagnosis included a thrombosis of the transcatheter mitral valve-in-valve implantation or deformation of the mitral valve stent. The latter could be ruled out by cinefluoroscopy showing neither gross geometric distortion nor decrease in diameter of the valve at the level of the annulus (Online Videos 3 and 4, cinefluoroscopy of prosthetic mitral valve). On empirical antithrombotic treatment we saw a significantly decreased transvalvular gradient and significant regression of the leaflets thickening confirming the diagnosis of bioprosthetic thrombosis (mid-TOE 2 chamber view of the prosthetic mitral valve in systole [D] and diastole [E], 3-dimensional TOE in diastole [F], Online Videos 5 and 6). LA = left atrium.
- Received November 13, 2013.
- Accepted November 26, 2013.
- American College of Cardiology Foundation