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(A) Preoperative echocardiography showed and (B) intraoperative findings of Case 1. The black arrow indicates the protruding mitral annulus tissue.
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F1
Her echocardiography showed a peak left ventricular outflow tract (LVOT) pressure gradient of 109 mmHg, left ventricular outflow peak velocity of 5.23 m/s, minimum LVOT diameter in anteroposterior dimension of 7 mm, and the thickness of muscular part of interventricular septum of 14-16 mm, causing severe LVOTO (Figure 1A). Intraoperative examination revealed that part of the sewing cuff of the previously implanted mitral prosthesis was covered with hyperplastic annulus fibrosus tissue, which protruded from the mitral annulus underneath the mechanical valve into the left ventricular outflow tract (Figure 1B) and that one prosthetic valve lobe failed to open completely.
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