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.