Prosthetic aortic valve dehiscence: a rocking valve

by Mohammed Ayman AbdelHay, MD, PhD; Moustafa Elwany, MD, Mahmoud Shehata, MD
Cardiology Department, Alexandria School of Medicine, Alexandria, Egypt

Clinical Case

  • 22-year old male
  • Previous aortic valve replacement with mechanical prosthesis
  • Recent worsening of dyspnea on exercise, no fever

Transthoracic two-dimensional echocardiography. Parasternal long- (left panel) and short-axis (right panel) views showing detachment and severe rocking (dehiscence) of the prosthesis in aortic position

Transthoracic two-dimensional echocardiography. Parasternal short-axis view at the level of left ventricular outflow tract (right panel) with color Doppler (left panel) showing severe paravalvular leak extending from 7 to 5 o’clock

Three-dimensional transesophageal echocardiography.  Zoom acquisition of the aortic valve showed from different perspectives to show  the opening of the leafiest and the extent of the rocking

Key messages

2D echocardiography:

  • Enabled the correct diagnosis with limited visualization of the prosthesis occluders

3D echocardiography:

  • Assessment of the prosthesis anatomy and occluder motion
  • Anatomically sound visualization of the extent of the dehiscence to allow surgical planning

References:

  1. Lancellotti P, Pibarot P, Chambers J et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging (2016) 17 (6): 589-590

Mohamad Ayman Abdel-Moniem Abdel-Hay, MD, PhD

Mohamad Ayman Abdel-Moniem Abdel-Hay is Professor of Cardiology- Faculty of Medicine, Alexandria University since September 2005. Currently, he is the Chairman of the cardiology department and the Director of the Adult Echocardiography Laboratory – Faculty of Medicine, Alexandria University. Egypt.
He graduated from Alexandria University school of Medicine, in 1981 (grade “Excellent with Honors”). He got his Master Degree in Internal Medicine, Alexandria University, in 1985 (grade Excellent) and got his Doctor Degree in Cardiology, Alexandria Universty in 1991.
Memberships: Egyptian Society of Cardiology; Board of Directors of Egyptian Echocardiography Working Group; and European Society of Cardiology.