A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

Division

Gulf Coast

Hospital

Corpus Christi Medical Center

Document Type

Case Report

Publication Date

12-4-2020

Keywords

paravalvular leak, mitral valve replacement, echocardiography - heart failure - valvular heart disease, aortic valve replacement, transthoracic echocardiogram, transesophageal echocardiogram, prosthetic heart valve, mitral regurgitation

Disciplines

Cardiology | Cardiovascular Diseases | Internal Medicine | Surgical Procedures, Operative

Abstract

Paravalvular leaks (PVL) are an uncommon sequelae of valve replacement but can be seen as a complication of both mechanic and prosthetic valves. Patients with PVL may remain asymptomatic or have detrimental complications, which include heart failure, hemodynamically significant hemolysis, and endocarditis. Management depends on the clinical presentation and the degree of the valvular leak. We hereby present a case report of a patient with a complicated clinical course secondary to a PVL of the mitral valve. The patient had a recent mitral valve replacement and presented with symptoms of heart failure that was refractory to standard medical therapy. Valvular abnormality was not seen with initial trans-thoracic echocardiogram (TTE), but with high clinical suspicion, a trans-esophageal echocardiogram (TEE) was done confirming a PVL. The patient’s condition continued to deteriorate; he became hemodynamically unstable with end-organ damage. Cardiothoracic surgery was consulted for surgical repair of the PVL. The patient, however, remained too unstable for surgery and the family opted for comfort measures per the patient’s wishes.

Publisher or Conference

Cureus

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