3D transoesophageal echocardiography in evaluation of mitral valve annuloplasty ring dehiscence.

Case summary

A 60-year-old man with severe mitral regurgitation secondary to P2 scallop prolapse, ejection fraction 50–55% and left ventricular enlargement underwent minimally invasive mitral valve repair with 28 mm Memo annuloplasty ring. The post-operative transoesophageal echocardiogram (TOE) showed minimal regurgitation. Subsequently, patient had significant resolution of symptoms. Three months after the surgery, the patient presented with worsening shortness of breath. Transoesophageal echocardiogram at that time showed large area of crescent shaped dehiscence (extending from 8 to 2 o’clock on the surgeon’s view of mitral valve), rocking prosthetic ring, and severe perimitral ring regurgitation. The regurgitant jet occupied the entire area of dehiscence (Figures and ). Patient was referred for reoperation.

Shown is a colour compare (2D on the left, colour on the right): in mid-systole the mitral ring (arrow) bounces above the mitral annulus causing severe mitral regurgitation as shown in colour. LA, left atrium; LV, left ventricle.

3D surgeons view of mitral valve, looking down from left atrial perspective, reveals large area of dehiscence (arrows). LAA, left atrial appendage; Ao, ascending aorta; just above aortic valve, MAR, mitral annuloplasty ring.

Although 2D TOE clearly documented dehiscence, the 3D TOE is highly valuable in determination of exact site of dehiscence by ability to visualize the valve from left atrial prospective (surgeon’s view) and to locate the site of regurgitation. It is likely that the mitral ring implanted was undersized, which led to dehiscence and severe perivalvular leak.

Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.

Conflict of interest: none declared.