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Transesophageal echocardiographic imaging of multiple complications following mitral valve replacement

Echo Research & Practice volume 2, pages K37–K41 (2015)Cite this article

Abstract

We present a case of mitral valve (MV) replacement that resulted in multiple complications, as diagnosed by transesophageal echocardiography (TEE), including left ventricular outflow tract obstruction, aortic dissection and left ventricular rupture. We also describe that identification of bleeding originating from the posterior aspect of the heart by the surgical team should trigger a complete TEE evaluation for adequate diagnosis. An 84-year-old woman underwent a MV replacement. Weaning from cardiopulmonary bypass (CPB) revealed a late-peaking gradient of 44 mmHg over the left ventricular outflow tract caused by obstruction from a bioprosthetic strut. After proper surgical correction, TEE evaluation showed a type A aortic dissection that was subsequently repaired. After separation from CPB, the surgical team identified a major bleed that originated from the posterior aspect of the heart. Although the initial suspicion was injury to the atrioventricular groove, a complete TEE evaluation confirmed a left ventricular free wall rupture by showing the dissecting jet using colour-flow Doppler. TEE is an essential component in cardiac surgery for assessment of surgical repair and potential complications. Posterior bleeding should trigger a complete TEE examination with assessment of nearby structures to rule out a life-threatening pathology. Left ventricular free wall rupture can be identified using colour-flow Doppler.

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Funding

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

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Authors and Affiliations

  1. Université Laval, Quebec City, Quebec, Canada

    Charles L. Brassard MD, Claudia Viens MD FRCPC & André Denault MD FRCPC PhD

  2. Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada

    Pierre Couture MD FRCPC

Authors
  1. Charles L. Brassard MD
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  2. Claudia Viens MD FRCPC
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  3. André Denault MD FRCPC PhD
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  4. Pierre Couture MD FRCPC
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Corresponding author

Correspondence to Pierre Couture MD FRCPC.

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Brassard, C.L., Viens, C., Denault, A. et al. Transesophageal echocardiographic imaging of multiple complications following mitral valve replacement. Echo Res Pract 2, K37–K41 (2015). https://doi.org/10.1530/ERP-15-0026

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  • DOI: https://doi.org/10.1530/ERP-15-0026

Echo Research & Practice

ISSN: 2055-0464

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