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Separation anxiety: Extreme dehiscence of a mitral annuloplasty ring

Mary Mashicharan1, Ian Loke1, Viktor Zlocha2

  • 1Department of Cardiology, Glenfield Hospital, University Hospital Leicester, Leicester, UK.

Echocardiography (Mount Kisco, N.Y.)
|May 16, 2019
PubMed

Insights

Severe mitral regurgitation and dehiscence occurred 3 months after mitral valve repair due to endocarditis. Three-dimensional transesophageal echocardiography (3D TEE) proved superior in visualizing the mitral ring dehiscence.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Medical Imaging

Background:

  • Mitral valve repair can be complicated by dehiscence of the annuloplasty ring.
  • Endocarditis is a potential cause of mitral ring dehiscence, leading to severe mitral regurgitation.
  • Accurate visualization of mitral ring dehiscence is crucial for surgical planning and patient outcomes.

Observation:

  • A patient presented with acute pulmonary edema three months post-mitral valve repair.
  • Transesophageal echocardiography (TEE) revealed severe mitral regurgitation and an abnormal annuloplasty ring position.
  • Three-dimensional TEE (3D TEE) clearly showed extensive mitral ring dehiscence.

Findings:

  • Infective endocarditis caused by Strept. Mitis and Cristatus was confirmed on the explanted mitral ring.
  • The dehiscence of the annuloplasty ring was the direct cause of severe mitral regurgitation.
  • 3D TEE provided superior visualization and anatomical detail of the ring dehiscence.

Implications:

  • This case underscores the importance of considering endocarditis in patients with late complications after mitral valve repair.
  • 3D TEE is a valuable tool for diagnosing and characterizing mitral ring dehiscence.
  • Early identification and management of endocarditis are crucial to prevent severe hemodynamic compromise.
Keywords:
dehiscencemitral annuloplastymitral valve repairtransesophageal echocardiography

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