about 75 y old patient with condition after implantation of prosthesis in aortic position about 10 month ago. Actually the patient has no clinical afflictions, in TTE I saw a distinct increase of transprosthetic gradient (PGmean about 35-40 mmHg, LV-EF about 55%) and an large regurgitation jet (PHT 380 msec). In TEE so we could demonstrate an obstruction of the posterior disk, that explains the incrase of transprothetic gradient and distinct regurgitation jet. You can see in the 3D-reconstruction, that the post disk doesn´t move. This finding was confirmed by continious x-ray, where we could see no movement of one disk.
retrospectively, the reason for abstruction pf prothesis was an inappropriate anticoagulation with warfarine.