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Walid Gharzuddine - 2016-04-27

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Dr. Ahmad Al Ayouby Dr. Hassan Kazma - 2016-04-27

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Aortic regurgitation post mitral valve repair
Published on 2014-02-03 by Walid Gharzuddine
History and Findings

A 54 year old male underwent surgical repair surgical repair of posterior mitral leaflet prolapse with mitral regurgitation about three months prior to his latest presentation.  About two weeks post-operatively he was readmitted with pericardial effusion that was drained percutaneously and two weeks after that a left pleural effusion was also drained.

Two months later he presented with dyspnea on mild effort and orthopnea. On physical exam his pulse was regular. There was neck vein distention of about 10 cm above the manubrio-sternal angle at 90 degrees. A grade ¾ diastolic blowing murmur was heard at the left sternal border. The lungs were clear to auscultation.  He was not febrile and denied history of fever.

Echocardiography was performed. Please check the images showing the pre-operative mitral valve prolapse and eccentric mitral regurgitation with a large proximal iso-velocity surface area consistent with severe regurgitation. The second video shows absence of aortic regurgitation on the pre-discharge echocardiogram. The latest images (about two and a half months post-operatively) show the development of significant aortic regurgitation not present initially.

What is your diagnosis as to the possible cause of the new aortic regurgitation? What are plausible explanations?


Please share your ideas in the comments section below.


Next week the diagnosis and further details will be posted with a discussion and references.

video 1 Pre-0p. mitral regurgitation | video 2 Early post-op. | video 3 New aortic regurgitation


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