about 35 y old patient with condition after mitral-valve reconstruction (Carpentier-ring 36 mm) because of severe high-grad symptomatic mitral-valve insufficiency caused by mitral-valve prolapse and
implantation of mechanical aortic prosthesis because of bicuspid aortic valve (SJM double tilting disk-prosthesis 25 mm). You can see a small prolapse of posterior mitral valve but no relevant m itral
valve insufficiency, no elevated transprothetic gradient (PGmean 2,7 mmHg). I used tissue-imagening to demonstrate mitral-valve movement.
... in that vid you can see an floating structure high-suscipious for endocarditic vegetation with distinct elevation of transprothetic gradient.
Besides we could found a severe dynamic mitral valve regurgitation with excentric regurgitation jet without signs of mitral valve prolapse.
about 80 y old patient with cardial decompensation (known severe RV-insufficiency) with distinct peripheral oedema, pleural effusion and clinical afflictions of infection with distinct radidly
increased inflammatory values. The patient has a complicated clinical history. The most importatnt thing is condition after implantation of aortic bioprosthesis (SJM 23 mm) and within of 1 year an
endocarditis of aortic bioprosthesis (early-endocarditis of prothesis!!!) about 2 years ago. But then the patient was treated like a late-endocarditis of prothesis (treatment like endocarditis of
native valve), no result of bacterial tests.
Actually in TTE we found some interesting things: distinct elevated transprothetic gradient above the aortic bioprosthesis (PGmax. 90 mmHg, PGmean 50 mmHg, max. velocity 4,8 m/sec), middle till
hicghgrade mitral-valve insufficiency with excentric regurgitation jet; and a decompensated right ventricle with severe increased pulmonary pressure (PAPsystol. 85 mmHg, high-grade tricuspid
insufficiency, RAP assessed on dilatated IVC without collapsility about 10-15 mmHg > PAPs about 100 mmHg!!!!).
Look at the Part 2 (TEE)....
Unfortunately I couldn“t convert my pictures of distinct elevated transprotehtic gradients.
about 70 y old patient with condition after cardiac surgery 2 years ago with implantation of aortic bioprothesis because of severe aortic endocarditis with distinct paravalvular abscess. Actually the
patient was admitted to our ER/ hospital with chills, fever and other clinical afflications of severe infection. In TTE we couldn“t found any signs of endocarditis and no elevated transprothetic
Gradient of aortic bioprosthesis (SJM 25 mm). In TEE you can see a typical paraprothetic abscess of aortic bioprosthesis. Besides we found a mild till moderate mitral valve insufficiency and a
sweeping atrial pacemaker-lead into the right ventricle (condition after implantation of DDDR-pacemaker because of intermittend high-grade AV-block and chronotropic incompetency). Pacemaker leads are
definitely free of endocarditic vegetations.
young patient with acute dyspnoe (< 12h) and syncope. no fever but a new heart murmur. in the transesophageal echocardiography you can see a severe endocarditis of the mitral valve (AMS) with flail
leaflet of the AMS.