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.