Valvular surgery case example

A patient was referred to our clinic with increasing shortness of breath. This woman had had a mechanical artificial mitral valve implanted in 2004 after the original mitral valve had become leaky due to an infection. Since myocardial infarction was suspected, cardiac catheterisation was performed promptly. This showed that the problem was not myocardial infarction but malfunction of the mechanical mitral valve. Compared with a chest X-ray done in 2004, it is apparent that only one leaf was still mobile (see figure 1). One wing of this double-wing prosthesis was no longer moving. This caused poor flow of the blood from the lung into the major circulation, which explained the shortness of breath. Echocardiography confirmed this finding (see figure 1). The reason for the malfunction is most likely attributable to inadequate anticoagulation with warfarin.