An abnormal chamber-like structure after mitral valve replacement

Abstract

Clinical introductionA 59-year-old woman who underwent mitral valve replacement and tricuspid annuloplasty with the De Vega technique without a rigid ring 16 years ago for rheumatic mitral stenosis was referred to our hospital for aggressive dyspnoea and oedema of lower extremities refractory to diuretics. ECG showed atrial fibrillation. Transthoracic echocardiography reveal ed severe tricuspid regurgitation, preserved left and right ventricular systolic function, slightly elevated systolic pulmonary artery pressure and an abnormal chamber-like structure (see online supplementary video A). Hence, transoesophageal echocardiography (TE) was performed (figure 1, see online supplementary video B).SP110.1136/heartjnl-2016-311041.supp1 SP210.1136/heartjnl-2016-311041.supp2 Figure 1Mid-oesophageal four-chamber view of transoesophageal echocardiography.QuestionWhat is the diagnosis of this abnormal chamber-like structure?Left atrial massLocalised pericardial effusionLeft atrial dissectionHiatal herniaCoronary artery aneurysm

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“…The Image Challenge question8 asks you to make the diagnosis from an echocardiographic image (figure 4); the online videos are helpful in understanding the anatomy and physiology of this rare complication after mitral valve surgery.…”