P180 A STRANGE JET IN A PATIENT WITH A MECHANICAL AORTIC VALVE

Abstract

Abstract Clinical Case A 68–year–old male patient with a history of ischemic heart disease in three vessel coronary artery disease who underwent surgical myocardial revascularization in 2012 by CABG (LIMA to LAD); previous aortic valve replacement with mechanical prosthesis (2012); previous PMK implant in permanent AF. The patient arrived at our observation transferred from another hospital where, due to heart failure with new–onset severe left ventricular dysfunction, he had undergone a coronary examination with evidence of occlusion of LAD in the middle tract, patency of LIMA to LAD, severe LM/LCx stenosis followed by IVUS guided PTCA–DES stenting with final TIMI 3. During his hospitalization in our care unit he repeated trans–thoracic echocardiogram examination which documented: severe left ventricular dilatation with reduced EF (40%), left atriomegaly, bileaflet mechanical aortic prosthesis in place with normal systolic opening, normal trans–prosthetic gradients, absent peri or intraprosthetic regurgitation jet, moderate mitral valve regurgitation with central jet, right–sided sections of normal size and contractility in the absence of signs of increased pulmonary pressures. Color Doppler also documented a high–speed jet starting from the prosthesis–LAM interface directed towards the left atrium of unclear interpretation. To better interpretate this finding a transesophageal echocardiogram was performed which confirmed the correct functioning of the aortic mechanical prosthesis, absence of periprosthetic leaks and confirmed a high–speed jet directed from the prosthesis–LAM interface towards the left atrium compatible with perforation of the mitro–aortic continuity tissue. The patient was therefore sent for cardiac surgery and is currently awaiting reoperation.