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Endocarditis of aortic bioprosthesis Part 1 TTE

added by Emmel

Endocarditis of aortic bioprosthesis Part 1 TTE
Posted By: Emmel (2248 days ago)

Hello Pablo!

You are right: I assume that high grad mitral
valve insufficiency is caused by occlusioon of aortic bioprosthesis
with increased transprothetic gradient (increased afterload). In Part
2 (TEE) you can see the dynamic of mitral valve insufficiency by
increased blood pressure/ increased afterload: at a systolic pressure
of 105 mmHg we found a regurgitation of mitral insufficiency-jet into
the pulmonary veins. I have had no indications/ signs for acute mitral
valve insufficiency (no signs of endocarditis). Dialeted RV with high
RV-pressure is caused by mitral valve insufficiency (postcapillary
PH); there a no signs of lung deseases, except a "wet" lung (> 3
us-B-lines each intercostal view).
But what can we do with that
patient: formally he propably needs a surgical solution of
bioprosthesis-endocarditis with reconstruction of mitral valve and
propably a reconstruction of tricuspid valve. In my opinion actucally
that will annihilate that patient.

Best greetings,

Posted By: ohtusabes (2254 days ago)

Hello Jörg. Very nice clips. Congratulations.

interesting case.

What is the explanation for severe mitral
valve regurgitation? is acute in nature? is there endocarditis of

LV is really hiperdinamic... I asumme because of sepsis
and because of Mitral regurgitation...
Is mitral regurgitation
worst because of LV afterload? (big gradient in aortic

And RV high PsAP I interpreted because of
severe MR...left atria not adapted (LA area?) and postcapillary



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Added: 13-05-2012
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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.

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