Intermittent Mechanical Mitral Regurgitation: How Dynamic Real-Time Echo Outperformed Other Imaging Modalities

We present a case of intermittent transvalvular regurgitation of a mechanical mitral valve due to entrapment by a preserved posterior mitral valve leaflet which was not fully plicated in the suture line.

A 69-year-old man with a history of mechanical mitral and aortic valve replacements presented with dyspnea. Therapeutic international normalized ratio values. Echocardiography revealed intermittent severe mitral regurgitation every third cardiac cycle; no thrombi or vegetations. Fluoroscopy confirmed abnormal occluder motion. Cardiac computed tomography and magnetic resonance imaging showed normal occluder opening and closure. During the redo operation, it was noted that the old mitral prosthesis was implanted over a preserved posterior mitral leaflet that was blocking the posterior disk.

Intermittent mitral regurgitation after mechanical mitral valve replacement has not been addressed in the guidelines.

Intermittent transvalvular regurgitation is a rare complication of mitral valve replacement with preservation of the subvalvular apparatus. Echo plays a role to identify the cause of malfunction.