Dynamic left-ventricular tract outflow obstruction: a late complication of mitral valve replacement

The case presented is a 47-year-old woman with left-ventricular outflow tract obstruction which was the late complication of mitral valve replacement (4 years later). The diagnosis was made using two-dimensional Doppler echocardiography (echo-2D Doppler) and confirmed by cardiac catheterization. Protrusion of the prosthetic ring towards the intraventricular septum reducing the diameter of the outflow tract to 7-8 mm and creating a dynamic obstruction (30 mm Hg on cardiac catheterization, and 44 and 75 mm Hg on echo-2D Doppler basally and after isoamyl nitrite inhalation, respectively) was recorded. The echo-2D Doppler technique appears to be useful in detecting this postsurgical mitral complication.