A Case of Stuck Valve after Mitral Valve Replacement Preserving Posterior Leaflet

A 78-year old female was admitted on January 13,2006 due to respiratory dysfunction resulting from left heart failure accompanied by lung congestion. The patient had received a mechanical prosthetic valve (CarboMedics 27 mm) in mitral position with posterior leaflet preservation and tricuspid valve annulopasty on December 4, 2001. Echocardiographic examination revealed moderate mitral regurgitation and an elevated transvalvular pressure gradient of 36 mmHg, suggesting a prosthetic valve dysfunction. A cineradiogram showed that one of the leaflets of the prosthesis was completely immovable. Despite intensive medical treatment her dyspnea and oligurea persisted, and urgent surgical intervention was clearly indicated. At surgery one of the leaflets of the prosthesis was found to be covered by a pannus accompanied by thrombosis on both the atrial and ventricular sides. The pannus originated from the endocardium of the preserved posterior leaflet and had folded around the cuff of the prosthesis from the previous operation. The dysfunctioning prosthesis was replaced by another mechanical valve (CarboMedics 27 mm). A preoperatively diagnosed relapse of tricuspid regurgitation was also reconstructed using DeVega’s method. Though the patient initially required high doses of innotropic support and continuous hemodiafiltration, she recovered uneventfully and was discharged on the 51st postoperative day after adequate rehabilitation. When doing mitral valve replacement preserving the posterior leaflet, it must be confirmed that the movement of the leaflet is smooth