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Left ventricular outflow tract obstruction by a bioprosthetic mitral valve: diagnosis by cardiac computed tomography

Robin A Ducas1, Davinder S Jassal, Shelley R Zieroth

  • 1Department of Internal Medicine, St Boniface Research Centre, Manitoba, Canada.

Journal of Thoracic Imaging
|May 26, 2009
PubMed

Insights

Cardiac computed tomography (CT) identified a protruding bioprosthetic mitral valve strut causing persistent left ventricular outflow tract obstruction in a patient unresponsive to echocardiography. This highlights CT

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Echocardiography is the primary noninvasive cardiac imaging modality.
  • Advanced imaging is crucial when echocardiography yields inconclusive results.
  • Hypertrophic obstructive cardiomyopathy (HOCM) can persist post-intervention.

Observation:

  • A 42-year-old woman with HOCM experienced persistent left ventricular outflow tract (LVOT) obstruction symptoms after septal myectomy and mitral valve replacement.
  • Transthoracic echocardiography failed to identify the cause of her ongoing symptoms.
  • Cardiac computed tomography (CT) was employed for further diagnostic evaluation.

Findings:

  • Cardiac CT revealed a strut from the bioprosthetic mitral valve protruding into the LVOT.
  • This anatomical abnormality was the cause of the patient's persistent LVOT obstruction.
  • The findings underscore the limitations of echocardiography in specific complex cases.

Implications:

  • Cardiac CT is a valuable tool for diagnosing complex cardiovascular conditions when echocardiography is insufficient.
  • Accurate identification of prosthetic valve complications is essential for patient management.
  • This case emphasizes the importance of multi-modality imaging in cardiology.

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