Prosthetic Mitral Valve Obstructed by Occluder Device for Paravalvular Leak.

A 70-year-old man, with the history of rheumatic mitral valvulopathy, prosthetic mitral valve replacement, and two subsequent surgical reinterventions for infective endocarditis and paravalvular leak, presented with severe hemolytic anemia. Paravalvular leak of his prosthetic mitral valve was diagnosed. He received closure with two Amplatzer duct occluders and had symptomatic improvement. Unexpectedly, poor motion of the prosthetic valve was noted 5 months later. Multidetector-row computed tomography revealed closure of both leaflets of the mitral prosthesis in systole (Fig 1A; Ao = aorta; LA = left atrium; LV = left ventricle). During diastole (Fig 1B), one of the valve leaflets (black arrowhead), adjacent to the ductal occluder (white arrowhead), was immobile while another leaflet opened (arrow). The occluder obstructed the leaflet of the prosthetic valve (black arrowhead). He underwent a fourth reoperation. During surgery (Fig 2A, B), prosthetic valve function was compromised and restricted in a closed position in that the posterior leaflet (black arrowhead; star) was impinged on by the bigger occlusion device (white arrowhead) (arrow points to the mobile/unobstructed valve leaflet). The devices were removed, and the mitral valve was replaced with an ON-X mechanical valve. The patient had an uncomplicated postoperative course and is now doing well.Fig 2View Large Image Figure ViewerDownload (PPT)