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. 2020 Jul 15;2(8):1099–1102. doi: 10.1016/j.jaccas.2020.05.076

Central Illustration.

Central Illustration

Normal Anatomy Versus Pathology

Disruption of the aorto-mitral continuity causing a large dissection plane with disruption of the adventitia at the base of the aorta near the aortic valve annulus extending approximately 6 cm along the left atrial wall. Systolic flow was noted within this space with an exit point approximately 5 cm from the origin and flow continuing into the left atrium (LA) resulting in severe paravalvular native valve mitral regurgitation. The perforation below the aortic leaflet (1) induced blood flow across the aorto-mitral curtain causing dissection of the atrial wall and mitral leaflet (2). Subsequently, the anterior mitral leaflet dehisced allowing significant paravalvular leak (3). LV = left ventricle.