Pseudo‐mitral‐valve echogram following prosthetic mitral valve replacement

Abstract

Echocardiographic recordings from a patient with a prosthetic mitral valve revealed echoes within the left ventricular cavity that mimicked the motion pattern of a "normal" anterior mitral leaflet. The echo pattern was continuous, recorded from multiple views, and by two-dimensional images it was localized to the level of the papillary muscles. Although thrombus and vegetation are possibilities, this echo probably originates from a pliable chordal structure severed but not removed at the time of surgery. The apparent responsiveness to hemodynamic influences was striking, and we suggest that the prevalence and pathophysiologic implications of such findings are of potential import.

Echocardiographic findings in rheumatic mitral valve disease with chordal rupture

“…This pattern of ruptured chordal movement differs from that of chordae severed, but not removed, at mitral valve replacement surgery, which may give rise to echocardiographic appearances very similar to those of a normal anterior mitral valve leaflet. 6 It is concluded that chordal rupture in rheumatic mitral valve disease can be identified at M-mode echocardiographic examination by demonstrating abnormal, highly mobile echoes within the left ventricle. However, the degree of mobility and the position of these echoes will depend upon the length of the chorda, its original sites of attachment to papillary muscle and valve, and the point at which rupture has occurred.…”