about 80 y old patient, condition after heart surgery with aortic valve replacement (in the early 80´s) and implantation of DDD-pacemaker in context of intermittent sinu-atriale blockade, long AV-Block 1° (above 300 msec) and chronotropic incompetence. In TEE we could see the aortic valve prosthesis, but what kind of prosthesis it is? It looks like a tilting-disk-valve like medtronic-hall or bjork-shiley-valve (but this would be very unlikely). Unfortunately I couldn´t see the pivot struts and I couldn´t better focalize the regurgitation-flow. It exists no documents about this aortic prosthesis (in cw: mean pressure gradient is about 20 mmHg, Vmax about 2,4 m/s).
What does the community think about? Please comment!