The images show the results of contrast left ventriculography (Fig 1A⇓ and 1B⇓) and thoracic aortography (Fig 1C⇓ and 1D⇓) in a 51-year-old woman who presented with recent-onset dyspnea 5 years after mitral valve replacement (Edwards-Duromedics bileaflet prosthe- sis, Ø 27).
Fig 1A⇓ is a right anterior oblique projection of the left ventricle (LV) during systole. A filling defect is detectable on the ventricular side of the mitral valve prosthesis (MVP), suggesting a thrombus (T). During diastole (B), only one leaflet opens correctly (L). The low-density halo around the opened leaflet is due to dilution of the contrast by blood coming from the left atrium and passing through the lateral and central valve orifices.
Fig 1C⇓ and 1D⇓ are systolic and diastolic frames, respectively, in left anterior oblique projection. Concomitant aortic valve regurgitation allows retrograde LV cavity opacification. In this projection, the MVP has a circular appearance. In diastole (D), only the superior leaflet opens, whereas the inferior leaflet (asterisk) remains closed because it is blocked by the thrombus.
Inferior MVP leaflet thrombosis was confirmed at surgery (Fig 2⇓), and the patient successfully underwent new mitral valve replacement.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1995 by American Heart Association