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European Journal of Echocardiography 2008 9(1):148-151; doi:10.1016/j.euje.2007.05.007
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Images in cardiovascular medicine: prosthetic aortic valve and conduit dehiscence with large periconduit cavity, ascending aortic aneurysm and severe mitral regurgitation

Emma L. Ivens*,{dagger}, Christopher R. Thompson, Robert R. Moss, Bradley I. Munt and Hilton Ling

The Division of Cardiology and Cardiovascular surgery, St Paul's Hospital and the British Columbia, Vancouver, British Columbia, Canada

Received 9 March 2007; accepted after revision 4 May 2007; online publish-ahead-of-print 20 August 2007.

* Corresponding author. Queensland Cardiology, Holyspirit Northside Hospital, Rode Road, Chermside, Queensland, 4032, Australia. Tel: +61 7 38615622. E-mail address: emma.ivens{at}hotmail.com


  Abstract

Prosthetic aortic valve and conduit dehiscence with periconduit cavity and ascending aortic aneurysm is an uncommon complication of aortic root surgery. It is usually recognizable at echocardiography due to an abnormal position of the prosthetic valve and conduit in relation to the native aortic annulus in conjunction with an abnormal echolucent periconduit space that fills with color flow. Mitral regurgitation is an unusual complication of this condition.

We present a patient with severe mitral regurgitation secondary to prosthetic aortic valve and conduit dehiscence with a large periconduit cavity and aneurysm of the intervalvular fibrosa. The mechanism of mitral regurgitation is secondary to functional involvement of the anterior mitral valve leaflet and intervalvular fibrosa with anterior mitral leaflet restriction in conjunction with mild left ventricular remodeling. Significant mitral regurgitation persisted post resection of the periconduit cavity and aortic valve replacement, requiring mitral valve replacement.

This case study reports a new mechanism of mitral regurgitation in the setting of prosthetic aortic valve and conduit dehiscence.

Keywords: Prosthetic aortic valve; Aortic conduit; Mitral regurgitation; Periconduit cavity; Intervalvular fibrosa aneurysm

{dagger} Tel: +1 778 996 1660/+1 604 806 8018; fax: +604 806 8410.


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