International Journal of Cardiology 201 (2015) 210–211

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International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard

Letter to the Editor

Mass attached to mechanical mitral valve mimicking a thrombus Manuel Calvo-Taracido ⁎, Sergio Bustamante, Óscar Adasme, Sergio Kara, Jaime Merino, Rodolfo Pivetta, Matías Macedo, Roberto Marrero, Ricardo Fernández, José Miguel Puccio Hospital San José, Santiago de Chile, Chile

a r t i c l e

i n f o

Article history: Received 16 June 2015 Accepted 26 June 2015 Available online 21 July 2015 Keywords: Thrombus Mechanical mitral valve Papillary muscle rupture

a b s t r a c t Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function. This advantage has been demonstrated in functional mitral valve regurgitation as well as mitral valve regurgitation due to rheumatic disease. Regarding complications of this technique, several of them have been reported, papillary muscle rupture being one of them. We describe a clinical case of this weird but possible kind of complication. © 2015 Elsevier Ireland Ltd. All rights reserved.

1. Introduction

3. Discussion

We describe a clinical case of a 65-year-old woman who underwent a mitral valve replacement with a mechanical valve due to severe mitral regurgitation caused by rheumatic heart disease. She had come to the emergency department after having suffered dyspnea. Transthoracic echocardiography (TTE) was performed showing a proper functioning of the prosthesis, however, an image of a mass protruding into the left ventricular outflow tract (LVOT) was observed.

Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function [1,2]. This advantage has been demonstrated in functional mitral valve regurgitation as well as mitral valve regurgitation due to rheumatic disease [3,4]. Regarding complications of this technique, several of them have been reported, papillary muscle rupture being one of them [5,6]. Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijcard.2015.06.116.

2. Case report A 65-year-old woman came to the emergency department having suffered from dyspnea during the previous two weeks. A mitral valve replacement with preservation of subvalvular apparatus was performed the previous month. Examination showed a systolic murmur. No fever was detected. TTE showed a pedunculated and sessile mass protruding into the LVOT in the systole causing a significant dynamic obstruction (Videos A, B). These findings were confirmed with a transesophageal echocardiography which showed a pedunculated mass attached to the anterior mitral annulus (Video C) with a thrombus appearance (Fig. 1, Videos D and E). The patient underwent cardiac surgery revealing mass which corresponded to an anterolateral papillary muscle rupture (Fig. 2).

⁎ Corresponding author at: Hospital San José, San José St, 1196 (Independencia), Santiago de Chile 8380000, Chile. E-mail address: [email protected] (M. Calvo-Taracido).

http://dx.doi.org/10.1016/j.ijcard.2015.06.116 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.

Fig. 1. Mass dimensions.

Letter to the Editor

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Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] R. Hetzer, T. Drews, H. Siniawski, T. Komoda, J. Hofmetister, Y. Weng, Preservation of papillary muscles and chordae during mitral valve replacement: possibilities and limitations, J. Heart Valve Dis. 4 (1995) S115–S123. [2] M. Natsuaki, T. Itoh, S. Tomita, K. Furukawa, M. Yoshikai, H. Suda, H. Ohteki, Importance of preserving the mitral subvalvular apparatus in mitral valve replacement, Ann. Thorac. Surg. 61 (1996) 585–590. [3] L. Chen, B. Chen, J. Hao, X. Wang, R. Ma, W. Cheng, C. Qin, Y. Xiao, Complete preservation of the mitral valve apparatus during mitral valve replacement for rheumatic mitral regurgitation in patients with an enlarged left ventricular chamber, Heart Surg. Forum 16 (3) (Jun 2013) E137–E143. [4] U.K. Chowdhury, A.S. Kumar, B. Airan, D. Mittal, K.G. Subramaniam, R. Prakash, S. Seth, R. Singh, P. Venugopal, Mitral valve replacement with and without chordal preservation in a rheumatic population: serial echocardiographic assessment of left ventricular size and function, Ann. Thorac. Surg. 79 (6) (Jun 2005) 1926–1933. [5] L.E. Thomson, X. Chen, S.C. Greaves, Entrapment of mitral chordal apparatus causing early postoperative dysfunction of a St. Jude mitral prosthesis, J. Am. Soc. Echocardiogr. 15 (8) (Aug 2002) 843–844. [6] E. Casquero, V. Asorey, J. Lugo, G. Pradas, Ruptured papillary muscle after mitral valve replacement with preservation of subvalvular structures, J. Card. Surg. 25 (6) (Nov 2010) 694–695.

Fig. 2. Papillary muscle rupture. Surgical piece.

Mass attached to mechanical mitral valve mimicking a thrombus.

Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducin...
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