Case report
A 64-year-old female patient was admitted to our clinic with progressively worsening shortness of breath (New York Heart Association-Classification II-III), 6 months after surgical mitral valve repair and annuloplasty ring implantation for rheumatic mitral regurgitation (28 mm Memo 3D Record Livonova®). The procedure reports reported to us that coronary artery bypass grafting (LAD-LIMA, AO-saphenous-OM1) and tricuspid annuloplasty ring were done in the same process.
The patient’s physical examination showed apical diastolic murmur, mezocardiac systolic murmur and mild bilateral lower extremity oedema. Her laboratory parameters were near normal. She was using ramipril 2.5 mg 1x1, metoprolol 50 mg 1x1 and acetylsalicylic acid 100 mg 1x1. First of all, we performed transthoracic echocardiography (TTE) and the 28/13 mmHg gradient was observed in the mitral valve annuloplasty ring and increased systolic pulmonary artery pressure was also observed. After that, we decided to performed transoesophageal echocardiography (TEE). TEE findings showed that motions of the mitral valve leaflet were fine, but in the mitral annuloplasty ring there was an extreme constriction and increased gradient (Figure 1A-D, Video 1-2). The case was addressed at the council of cardiology and cardiovascular surgery, and recommended redo mitral valve surgery for the case, but the patient refused.