PMC3106971_01
(a) shows short-axis images of the aortic valve prosthesis. (A) is the aortic valve prosthesis 5 years after implantation demonstrating minimal calcification and thin, barely visible, leaflets. Shown on (B) is the prosthetic aortic valve about 2-years after beginning dialysis demonstrating heavy leaflet calcification (arrows). (b) shows the aortic valve prosthetic mean gradient by spectral continuous wave Doppler echocardiography demonstrating a normal gradient 5 years after implantation (A) and a markedly increased gradient shortly after beginning dialysis (B), corresponding to the images in (a). (c) shows the intraoperative transesophageal echocardiographic images of the stenotic aortic valve prosthesis at the time of the second aortic valve operation. Short-axis image on the left (A) and long-axis image on the right (B) demonstrate marked leaflet calcification, thickening, and severe stenosis.
IJN2011-386368.001.jpg
PMC3106971_01_IJN2011-386368.001.jpg
fig1
On review of prior echocardiograms, there was a rapid progression of the valve stenosis along with elevated serum calcium-phosphate product levels following the initiation of hemodialysis (Figure 1 and Table 1).  