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European Journal of Echocardiography 2007 8(1):15-16; doi:10.1016/j.euje.2005.12.008
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Copyright © 2005, The European Society of Cardiology

Echocardiography of acute mitral prosthesis dehiscence

Eloi Marijona,b,*, Phalla Oub, Dinesh Jania and Stéphane Aubertc

aInstituto do Coração, Maputo, Moçambique
bService de Cardiologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
cService de Chirurgie Cardiaque, Hôpital La Pitié Salpêtrière, Paris, France

Received 18 September 2005; received in revised form 30 November 2005; accepted after revision 15 December 2005.

* Corresponding author. Hôpital Necker-Enfants Malades, Service de Cardiologie Pédiatrique 149, rue de Sèvres, 75743 Paris Cedex 15, France. Tel.: +33 1 44 49 43 47; fax: +33 1 44 49 43 40. eloi_marijon{at}yahoo.fr


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We report a 20-year-old man with acute mitral prosthesis endocarditis complicated by valve desinsertion. In developing countries, the lack of surgical facilities makes management of these complications difficult.

Keywords: Endocarditis; Valvular prosthesis; Trans-thoracic echocardiography

A 20-year-old boy underwent cardiac surgery, mitral valve replacement with a Medtronic mechanical prosthesis, for severe rheumatic mitral disease. On the fifth postoperative day, he developed high fever and a grade III/VI mitral systolic murmur was heard. Trans-thoracic echocardiography showed a para-prosthetic leak (Figs. 1 and 2Go) with prosthesis dehiscence (Fig. 1, red arrow). Antibiotic therapy for staphylococcal prosthetic valve endocarditis1,2 was initiated and transfer for new surgery was organised. Unfortunately, a complete dehiscence occurred with immediate death few hours after his arrival in a surgical European center.


Figure 1
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  		Figure 1 Two-dimensional parasternal long axis view (color Doppler imaging) of severe important regurgitation between the left ventricular out-flow tract (LVOT) and the left atrium (LA) just underneath the aortic valve (AV) and valve dehiscence (red arrow). RV: right ventricle; AO: aorta.

 


Figure 2
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  		Figure 2 Two-dimensional parasternal short axis view (color Doppler imaging) showing para-prosthetic regurgitation originating from the high part of the mitral ring. LVOT: left ventricle out-flow tract; RV: right ventricle; MVP: mitral valve prosthesis; AO: aorta.

 
Direct signs of mitral valve desinsertion are rarely seen in trans-thoracic echocardiography. This report also insists on the difficulties to manage surgical cardiac emergencies in developing countries, after departure of the surgical team.


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  1. Wilson W.R., Karchmer A.W., Dajani A.S., Taubert K.A., Bayer A., Kaye D., et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. JAMA (1995) 274:1706–1713. American Heart Association.[Abstract/Free Full Text]
  2. Bayer A.S., Bolger A.F., Taubert K.A., Wilson W., Steckelberg J., Karchmer A.W., et al. Diagnosis and management of infective endocarditis and its complications. Circulation (1998) 98:2936–2948.[Free Full Text]

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This Article
Right arrow Abstract Freely available
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