Mechanical mitral valve prosthesis dysfunction from thrombus: transesophageal echocardiography has limitations

Transesophageal echocardiography (TEE) is a useful clinical tool for the evaluation of a variety of cardiovascular lesions. In particular, TEE has been demonstrated to be a better diagnostic modality in the visualization of mechanical prosthetic heart valves than transthoracic echo-cardiography (TTE). Furthermore, TEE is noted to be particularly useful to evaluate the atrial surface of mitral prostheses, the usual location of thrombi or vegetations. We herein describe a patient with a dysfunctional St. Jude's mitral prosthesis resulting from an organized thrombus who underwent both TTE and TEE without visualization of the thrombus.