Stuck on a diagnosis: prosthetic mitral valve thrombosis vs dyssynchrony

Summary

Prosthetic valve thrombosis is a rare but serious complication of mechanical valve replacement requiring prompt diagnosis and treatment. Unfortunately, it is often difficult to evaluate this based on single modality imaging alone. We demonstrate a case where the use of both 3D-TOE and valve fluoroscopy allowed for the differentiation between prosthetic valve thrombosis vs prosthetic mitral valve dyssychrony. Using transoesphageal echocardiography, it is noted that there is valve dyssynchrony; however, it is unclear if there is leaflet restriction (Video 1). Using fluoroscopy, it can be seen clearly that their overall mobility is normal (Video 2). Additionally, using 3D-TOE it can be clearly noted that there is no evidence of pannus or thrombus (Video 3). Using these two imaging modalities in concert facilitated the clear diagnosis of valve dyssynchrony vs valve thrombosis.

Video 1

Transoesophageal echocardiography demonstrating mobile prosthetic mitral valve leaflets with dyssynchronous closure. View Video 1 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-20-0012/video-1.

Download Video 1 ^{(6.4MB, avi)}

Video 2

Valve fluoroscopy demonstrating prosthetic mitral and aortic valve replacement. Of note, the mitral valve (on the right hand side) demonstrates dyssynchronous closure of both leaflets. View Video 2 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-20-0012/video-2.

Download Video 3 ^{(1.1MB, avi)}

Video 3

3D-Transoesophageal echocardiography demonstrating mobile prosthetic mitral valve leaflets with dyssynchronous closure. Of note, there is no evidence of pannus or thrombus. View Video 3 at http://movie-usa.glencoesoftware.com/video/10.1530/ERP-20-0012/video-3.

Download Video 3 ^{(1.7MB, avi)}

Declaration of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this article.

Funding

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Patient consent

Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient.