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[Dynamic obstruction of the left ventricular outflow tract by prosthesis dysfunction]
P Yang1, F Weidinger, A Hassan
1Universitätsklinik für Innere Medizin II, Abteilung Kardiologie, Wien, Osterreich.
Zeitschrift Fur Kardiologie
|April 1, 1995
Summary
A bioprosthetic mitral valve failure caused dynamic left ventricular outflow tract obstruction in a patient. This rare complication, occurring 13 years post-surgery, led to low cardiac output and required reoperation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Mitral valve replacement with bioprostheses is a common procedure.
- Prosthetic valve dysfunction can occur years after implantation.
- Left ventricular outflow tract (LVOT) obstruction is a potential complication.
Observation:
- A 46-year-old patient developed dynamic LVOT obstruction 13 years after mitral valve replacement with a Hancock bioprosthesis.
- The prosthesis was noted to be oversized and abnormally positioned, with struts projecting into the LVOT.
- The patient experienced mitral regurgitation due to prosthesis failure, leading to severe LVOT narrowing during systole.
Findings:
- The dynamic LVOT obstruction was caused by the bioprosthesis strut impinging on the outflow tract during systole.
- This complication resulted in low cardiac output syndrome.
- Echocardiographic findings revealed chronic mild LVOT obstruction exacerbated by hypercontractile cardiac function secondary to mitral regurgitation.
Implications:
- This case highlights a rare but serious complication of bioprosthetic mitral valves.
- Abnormal prosthesis positioning and oversizing can predispose to dynamic LVOT obstruction.
- Prompt diagnosis and surgical intervention are crucial for managing such cases.