Severe Mitral Regurgitation Due to a Small Fracture of a Prosthetic Valve

Mitral valve dysfunction due to a fracture and escape of a mitral leaflet prothesis is a complication described with mitral mechanical prothesis.1Lee SY Kim EK Park TK et al.Acute prosthetic mitral valve dysfunction due to non-traumatic fracture of prosthesis.Eur Heart J. 2019; 40: 494Crossref PubMed Scopus (1) Google Scholar, 2Morrical BD Dearani JA Cabalka AK Melody valve in mitral position: Complete fracture causing acute mitral stenosis in a child.Catheter Cardiovasc Interv. 2019; 93: E101-E104Crossref PubMed Scopus (4) Google Scholar, 3Ozsarac M Karcioglu O Ayrik C et al.Red flag in the emergency department: Fracture and primary failure of a prosthetic valve.J Emerg Med. 2005; 29: 49-51Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar However, severe mitral regurgitation, with normal movement of the 2 leaflets of the mechanical valve prothesis, as observed on echocardiographic examination for a 67-year-old female patient described herein, is an unusual complication (Fig 1, A-C). The patient was admitted to our hospital with dyspnea and edema in the lower limbs. She had a history of mitral and aortic mechanical valve replacement 13 years prior. Transesophageal echocardiography showed correct closure of the leaflets of the mitral prothesis (see Fig 1, A and B); intraprosthetic mitral leak with severe mitral regurgitation (Fig 1, C and D); severe tricuspid regurgitation; and severe pulmonary hypertension. The patient was scheduled for mitral and tricuspid replacement surgery. During the procedure, macroscopic examination revealed a fracture in the medial part of 1 leaflet of the mitral valve prosthesis with a missing fragment on its edge (Fig 1, E) which was responsible for its insufficiency. The valve was explanted and replaced. The patient experienced a torpid postoperative period and died 20 days after the surgery.