Intraoperative Evaluation of Paravalvular Regurgitation by Transesophageal Echocardiography

TL;DRAbstract

A 67-year-old man is undergoing mitral valve replacement for rheumatic mitral stenosis with a mechanical prosthetic valve. After separation from cardiopulmonary bypass (CPB), an eccentric mitral regurgitation jet was noted, originating from outside the prosthetic sewing ring. Further evaluation was pursued. Paravalvular regurgitation or leak (PVL) is a complication associated with the implantation of a prosthetic heart valve. PVL represents pathologic regurgitation originating outside the sewing ring because of incomplete apposition of the prosthetic valve against the native annulus. The incidence of PVL is approximately 15% immediately after elective valve replacement; long-term incidence of PVL may be higher.1 Although most PVLs do not require surgical intervention, a severe PVL may cause heart failure symptoms or hemolytic anemia from turbulence.2 Late PVL results from suture dehiscence, whereas early PVL relates to surgical technique and usually presents in the operating room.3 Fac

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