J Cardiovasc Ultrasound.  2012 Mar;20(1):63-66. 10.4250/jcu.2012.20.1.63.

A Remnant Mitral Subvalvular Apparatus Mimicking Aortic Valve Vegetation after Mitral Valve Replacement

• Kim HJ
• Kim KH
• Choi JS
• Kim JS
• Kim MA
• Zo JH

• KMID: 2177345
• DOI: http://doi.org/10.4250/jcu.2012.20.1.63

Abstract

Preservation of the subvalvular apparatus has the merits of postoperative outcomes during mitral valve replacement for mitral regurgitation. We performed mitral valve replacement with anterior and posterior leaflet chordal preservation in a 65-year-old woman. On the 2nd postoperative day, routine postoperative trans-thoracic echocardiography showed an unknown aortic subvalvular mobile mass. We report a case of a remnant mitral subvalvular apparatus detected by echocardiography after chordal preserving mitral valve replacement which was confused with postoperative aortic valve vegetation.

Keyword

Mitral valve replacement; Subvalvular apparatus; Vegetation

MeSH Terms

Aged
Aortic Valve
Echocardiography
Female
Humans
Mitral Valve
Mitral Valve Insufficiency

Figure

• 

  Fig. 1 A: Preoperative transesophageal echocardiography demonstrating severe mitral regurgitation with the prolapse of the anterior leaflet of the mitral valve. B: Showing color doppler across the mitral valve with severe regurgitation jet. Ao: aorta, LA: left atrium, LV: left ventricle.

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  Fig. 2 A: Postoperative transthoracic echocardiography parasternal long axis view showing a mobile mass (arrow) around the aortic valve and normal function of the mechanical valve. B: Doppler image shows that there is no leakage and a well-functioning mechanical mitral valve. LA: left atrium, LV: left ventricle.

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  Fig. 3 A: Preoperative TTE demonstrating AV without abnormal structure. B: On the 7th postoperative day. C: On the 14th postoperative day. D: On the 21st postoperative day. The transthoracic echocardiography showed 0.3 × 0.6 cm remnant leaflet (arrow) of the mitral valve and no significant change in mass size. AV: aortic valve, Ao: aorta, LA: left atrium, LV: left ventricle, TTE: trans-thoracic echocardiography.

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