Separation anxiety: Extreme dehiscence of a mitral annuloplasty ring

Abstract

We report a patient admitted with acute pulmonary edema 3 months after mitral valve repair, with no history of inter‐current febrile illness. Transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) and an abnormally positioned annuloplasty ring, suggestive of dehiscence. The extreme extent of ring dehiscence was visualized on 3‐dimensional TEE (3D), with near‐complete separation of the ring. Strept.Mitis and Cristatus were isolated from the ring following redo mitral valve surgery, confirming endocarditis as the mechanism for dehiscence. This report highlights the additive role and superior ability of 3D TEE in the identification and anatomic delineation of mitral ring dehiscence.

Clear Demonstration of Different Mechanisms of Severe Mitral Regurgitation Caused by the Mitral Ring Dehissence during Transesophageal Echocardiography

“…Ring dehiscence is a rare clinical entity that usually leads to severe MR and requires urgent or emergent surgical reoperation (1). Endocarditis, trauma, or procedure-related issues may be responsible to trigger the dehiscence process and progressive left ventricular geometric remodeling may also provoke recurrence (2,3). Characteristics of the tissue at the ring attachment areas are another important factor so, weak and calcified tissues are more prone to separation from the ring(3).…”