Shortness of Breath and Palpitations

A 67-year-old man complains of shortness of breath and palpitations. He had robotic mitral valvular surgery 1 year ago.

Figure 55-1.

Figure 55-2.

QUESTION 1. Based on this 2D three-chamber transesophageal echocardiogram (TEE) view (Fig. 55-1), the patient has:

A. A vegetation on the mitral valve

B. A bioprosthetic mitral valve

C. A mitral valve ring

D. A mechanical mitral valve

View Answer

ANSWER 1: C. The patient has a mitral valve ring after mitral valve repair. The asterisk depicts an enlarged left atrium. The two block arrows point to the medial and the lateral portion of the mitral ring. Below the ring is the native mitral valve with thin arrows pointing to the anterior (left) and the posterior leaflet (right).

QUESTION 2. See Figure 55-2. The mitral regurgitation (MR) is:

A. Severe and central through the mitral valve (i.e., valvular)

B. Severe and paravalvular

C. Severe, both valvular and paravalvular

D. Moderate, both valvular and paravalvular

View Answer

ANSWER 2: C. There is severe MR through both of the mitral leaflets as demonstrated by a medially directed jet toward the center of the picture. There also appears to be two jets of paravalvular MR on the lateral aspect of the valve. The lateral position of the ring is still seen as a bright echo density separating the valvular from the paravalvular jets.