Recurrent Pulmonary Edema in a Patient With a Prosthetic Mitral Valve

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Presentation transcript:

Recurrent Pulmonary Edema in a Patient With a Prosthetic Mitral Valve Joris Schurmans, MD, Bert Ferdinande, MD, Siegmund Keuleers, MD, Paul Herijgers, MD, PhD, Werner Budts, MD, PhD The Annals of Thoracic Surgery Volume 88, Issue 3, Pages 996-998 (September 2009) DOI: 10.1016/j.athoracsur.2009.01.038 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Simultaneous electrocardiogram and radial pressure curve recordings showing a sinus rhythm with rate of 94 bpm (upper panel) with intermittent pulse pressure drop (arrow) from plus minus 170 to 133 mm Hg in a 1:2 ratio (lower panel). (B) Continuous wave Doppler (transthoracic echocardiogram) recordings through the mitral valve prosthesis (Bjork-Shiley) showing “obstruction alternans” pattern of low-intensity prosthetic valve opening-closing signal (gray double arrow) with (near) absence of diastolic mitral valve flow (vertical arrow) alternated with the (normal) high-intensity prosthetic valve opening-closing signal (white double arrow), with increased mitral valve flow velocities (obstructive flow) (horizontal arrow). Electrocardiographic recordings (bottom) show a sinus rhythm of 90 bpm. (C) Continuous wave Doppler (transthoracic echocardiography) through the mitral valve prosthesis (Bjork-Shiley) showing normal function and gradient. The Annals of Thoracic Surgery 2009 88, 996-998DOI: (10.1016/j.athoracsur.2009.01.038) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (Panel A) Perioperative view of the Bjork-Shiley mechanical mitral valve with fibrous overgrowth (arrow). (Panel B) Perioperative view of the Bjork-Shiley mechanical mitral valve after removing fibrous overgrowth. (Panel C) Surgically removed circumferential fibrous overgrowth. The Annals of Thoracic Surgery 2009 88, 996-998DOI: (10.1016/j.athoracsur.2009.01.038) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions