PMC7243375_01
The initial transthoracic echocardiogram on presentation showing a mean pressure gradient of 20 mm Hg across mitral valve prosthetic along with fixed posterior leaflet and partially restricted anterior leaflet with no visible mass.
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Mitral valve Doppler Velocity Index was 3.85, and a pressure half-time was 254 ms (Figure 1).
Repeat transesophageal echocardiogram after 2 rounds of fibrinolytic therapy showing improvement in the mean pressure gradient across the prosthetic mitral valve at 8 mm Hg along with a normal movement of the anterior leaflet and persistent fixed posterior leaflet.
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Further evaluation with a transesophageal echocardiogram (TEE) showed a fixed posterior leaflet and a partially restricted anterior leaflet of the prosthetic mitral valve with no visible mass and a mean gradient of 42 mm Hg at a heart rate of 87 beats per minute (Figure 2).
Follow up transesophageal echocardiogram 28 days postdischarge showing normal mean pressure gradient across the mitral valve prosthetic along with normal movement of the anterior leaflet and properly functioning posterior valve leaflet.
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Repeat TTE following the second course showed further improvement in the mean gradient across the prosthetic mitral valve from 18 mm Hg to 8 mm Hg, normal movement of the anterior leaflet, and persistent fixed posterior leaflet (Figure 3).