Detailed Treatment Process
5 min read
Female, 54 years old, underwent mechanical aortic and mitral valve replacement 16 years ago. She was recently hospitalized for recurrent atrial fibrillation and related issues. This is the echocardiogram report prior to perivalvular leak closure: (27 June) Department: Cardiology Examination Modes: M-mode, 2D echocardiography, Doppler (Pulsed Wave, Continuous Wave, Color Flow) I. Main Measurements (unit: mm) Name | Measured Value (Normal Range) Aortic root diameter | 27 (20-37 mm) Left ventricular end-systolic diameter | 34 (20-37 mm) Left ventricular end-diastolic diameter | 55 (35-56 mm) Left atrial diameter | 57 (19-40 mm) Interventricular septum thickness | 11 (6-11 mm) Left ventricular posterior wall thickness | 11 (6-11 mm) Main pulmonary artery | 30 (19-27 mm) III. Echocardiographic Findings: Compared with the previous study on 24 January last year: 1. Left atrial diameter has slightly increased; left ventricular diameters are similar to previous and remain within normal range; left ventricular wall is not thickened, and resting wall motion is normal. 2. Mechanical aortic valve shows normal ring fixation with clear leaflet echoes; continuous-wave Doppler estimates peak transvalvular pressure gradient at approximately 52 mmHg; no significant paravalvular regurgitation on color Doppler. 3. Mechanical mitral valve shows ring-tissue separation of about 4 mm in the anterolateral quadrant with limited ring mobility; leaflets open and close adequately; continuous-wave Doppler estimates effective orifice area of approximately 2.1 cm²; color Doppler detects mild to moderate paravalvular regurgitation. 4. Right atrial and ventricular diameters are normal; pulmonary artery is dilated; continuous-wave Doppler estimates pulmonary artery systolic pressure at approximately 52 mmHg based on mild tricuspid regurgitation. 5. Other findings unchanged from previous study. IV. Conclusion: Status post mechanical mitral and aortic valve replacement: No significant dysfunction of mechanical valves Moderate pulmonary hypertension Date: 27 June
This is the echocardiogram report after perivalvular leak closure: (8 July) Department: Cardiac Surgery Examination Modes: M-mode, 2D echocardiography, Doppler (Pulsed Wave, Continuous Wave, Color Flow) I. Main Measurements: (unit: mm) Name | Measured Value | Normal Range Aortic root diameter | 30 (20-37 mm) Left ventricular end-systolic diameter | 33 (20-37 mm) Left ventricular end-diastolic diameter | 53 (35-56 mm) Left atrial diameter | 50 (19-40 mm) Interventricular septum thickness | 11 (6-11 mm) Left ventricular posterior wall thickness | 11 (6-11 mm) Main pulmonary artery | 30 (19-27 mm) III. Echocardiographic Findings: Compared with 27 June: 1. Left atrial diameter remained enlarged but slightly smaller; left ventricular diameters similar and still within normal range; left ventricular wall not thickened; left ventricular systolic motion normal at rest. 2. Occluder echo visible in the anterolateral quadrant of the mechanical mitral valve; normal shape and stable position; leaflets opened and closed normally; continuous-wave Doppler estimated orifice area approximately 2.1 cm², mean transvalvular pressure gradient approximately 4 mmHg; color Doppler showed mild paravalvular regurgitation. 3. Right atrial and ventricular diameters normal; pulmonary artery still dilated; color Doppler showed trivial tricuspid regurgitation. 4. Remaining findings unchanged from previous study. IV. Conclusion: Status post mitral and aortic valve replacement (DVR + MVR) with left-sided occluder placement: mild paravalvular regurgitation of mechanical mitral valve Date: 8 July
The patient was hospitalized and underwent perivalvular leak closure and radiofrequency ablation. Post-procedure, she reported feeling generally unwell and developed persistent sallow complexion. After discharge, she returned for several follow-up visits. Echocardiography continued to show mild-to-moderate paravalvular leaks with regurgitation around both the mitral and aortic mechanical valves, along with moderate pulmonary hypertension. Regarding the sallow complexion, after approximately six months of ongoing medical visits, a doctor finally explained that it resulted from the perivalvular leak occluder. The metal device implanted in the heart caused high-velocity blood flow to shear red blood cells, leading to mechanical hemolysis, elevated bilirubin, and severe hemolytic anemia. This was the cause of her jaundiced appearance. Subsequently, she underwent “minimally invasive redo mitral valve replacement” at another hospital but died during the perioperative period. The following is the surgical record: 7 February next year 20:57 Surgical Record Date of Surgery: 7 February Procedure: Minimally invasive redo mitral valve replacement Preoperative Diagnosis: Status post double valve replacement; status post mitral moderate paravalvular leak closure; moderate pulmonary hypertension; persistent atrial fibrillation; hemolytic anemia; hyperbilirubinemia Intraoperative Diagnosis: Status post double valve replacement; status post mitral moderate paravalvular leak closure; moderate pulmonary hypertension; persistent atrial fibrillation; hemolytic anemia; hyperbilirubinemia Anesthesia: General anesthesia Surgical Course: Incision: Right 4th intercostal space Patient position: Right side elevated 30 degrees Right pleura ruptured; adhesions present in pleural cavity; no pleural effusion Pericardial adhesions present, no effusion. Cardiac enlargement: Right atrium +, right ventricle +, left atrium ++, left ventricle ++ Pulmonary artery diameter (___) cm, aortic diameter (___) cm. Thrill locations: Systolic (+, ++, +++) sites / Diastolic (+, ++, +++) sites Digital exploration: Not performed Left atrial incision: Via interatrial groove, length 4 cm. No thrombus in left atrium Mitral valve pathology: Mechanical mitral prosthesis opened without restriction; granulation tissue proliferation around the annulus; paravalvular leak involving approximately half the circumference; occluder visible within the leak and removed intraoperatively; prosthetic valve excised along the annulus. After valve excision: Annulus diameter 2.8 cm Prosthetic valve selected: Mechanical valve Valve type: Internal diameter __ cm, external diameter 2.7 cm St. Jude valve Suture technique: Mitral – pledgeted interrupted mattress sutures Total 13 sutures for mitral valve Valve seating: Within the annulus Additional procedures: None Left atrial closure: 3-0 Prolene continuous two layers Pericardial closure: Drainage: One right chest drain Chest closure: Interrupted one layer, continuous two layers