Delineation of A Paravalvular Leak Origin Between A Rigid Mitral Ring and Supra-Annular Implanted Mechanical Mitral Prosthetic Valve

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Paravalvular leakage is not a rare condition among patients with mitral prostheses. Two-dimensional echocardiographic approaches are not sufficient to determine the origin of paravalvular leak that occurs after prosthetic mitral valve replacement. Real-time three-dimensional transesophageal echocardiography provides detailed structural identification of paravalvular leak origin and defect morphology compared to two-dimensional transesophageal echocardiography. Here we present a patient with paravalvular mitral regurgitation from a slit like defect between the mitral anular ring and the prosthetic valve delineated with the utility of 3D fullvolume and 3D color flow imaging modalities.