Background: Left ventricular outflow tract (LVOT)
obstruction is a serious complication that can occur after various
mitral-valves, surgical or percutaneous, interventions. It was rarely described in mechanical mitral
valve replacements. Aim: To analyze a
case of late LVOT obstruction after a mitral valve replacement by a low-profile
mechanical prosthesis in the light of a review of the literature. Case
Presentation: A 48-year old woman, with a history of rheumatic mitral valve
disease and mechanical mitral replacement by a hemi-disc valve 18 years ago,
presented for a recent dyspnea. Echocardiography showed a narrowing of the
LVOT, with anterior position of the mitral prosthesis, aorto-mitral annular
angulation, septal thickening and remnant native sub-valvular tissue attached
to the septum in the LVOT region. This resulted in LVOT obstruction with a peak
gradient of 75 mmHg. The heart team opted for a redo surgery, but the surgical
decision was refused by the patient.
Discussion: LVOT obstruction after mitral valve replacement was mainly
related to preserved native mitral valve tissue, but we highlighted that other
causes can contribute to it like septal thickening and anterior prosthetic
position. Aorto-mitral annular angulation that was identified as a risk factor
of LVOT obstruction after trans-catheter mitral valve replacements, should be,
probably, also took into account and assessed pre-operatively in patients
undergoing surgical mitral replacements.
Conclusion: LVOT obstruction can occur after mechanical mitral
replacements event with low profile prosthesis. In patients with identified
risk factors preservation mitral anterior leaflet should be avoided, and
preservation of other native mitral tissue should be discussed.
Author(s) Details
Fathia Mghaieth Zghal Rabta University Hospital of Tunis, Tunisia and University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia.
View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/212
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