Intermittent trapping of a tilting-disc mitral prosthesis

Abstract

A 57-year-old woman presented to our emergency room complaining of palpitations and crescent dyspnea. She had carried a tilting-disk mitral valve prosthesis since 1985. The ECG showed atrial tachycardia with 2:1 conduction (Figure 1). Her arterial pressure was 75/50 mm Hg, but signs of hypoperfusion were not apparent. On heart auscultation, prosthetic clicks were erratically audible. Transthoracic and transesophageal echocardiograms were performed (Figure 2A). They demonstrated that the valve opened once between 3 and 4 beats (Movies I and II). This point was confirmed by means of an invasive arterial pressure line showing alternant effective beats (Figure 1). After sinus rhythm was restarted with one 150-J shock, high gradients and velocities remained. After a thorough Doppler search, a high-pressure half-time of the ineffective beats was shown (Figure 2B).