Images in Cardiovascular Medicine Intermittent Cardiogenic Shock in a Man With Mechanical Prosthesis of the Aortic Valve

Intermittent dysfunction of prosthetic aortic valve is a rarebut life-threatening condition that may be difficult to recognize. Here, we present a case of 64-year-old man with a history of bicuspid aortic valve that had been replaced with a Medtronic-Hall prosthesis 15 years earlier. Until his current illness, he was fit, with good function of the valve and well maintained anticoagulation. After several days of progressive intermittent breathlessness, he experienced severe anginal chest pain, orthopnea, and dizziness that proceeded into an electromechanical dissociation. Circulation was restored after a brief resuscitation, intubation, and the administration of vasopressors by emergency medical services personnel. On admission to the intensive care unit, he had sinus rhythm with intraventricular conduction defect (Figure 1), stable blood pressure on vasopressors, and was ventilated for pulmonary edema (Figure 2). Nongated chest computed tomograph