case_images: PMC11734570_01
case_images: Preoperative transesophageal echocardiography, intraoperative findings, and postoperative contrast-enhanced computed tomography findings. a, b TEE shows severe mitral regurgitation with vegetation on both the anterior and posterior leaflets (A2, P3) (red arrows). c The vegetation was attached to the leaflets A2, A3, and P3, and there was also an abscess formation at the annulus, especially from P3 to the posterior commissure (red arrows). d and e Contrast-enhanced computed tomography reveals massive hematoma in the right thoracic cavity and pericardium (red arrows) and the extravasation from the left atrium (arrowheads). RV, right ventricle; LA, left atrium; LV, left ventricle; PE, pericardial effusion
case_images: 44215_2025_188_Fig1_HTML.jpg
case_images: PMC11734570_01_44215_2025_188_Fig1_HTML.jpg
case_images: Fig1
case_images: Transesophageal echocardiography (TEE) showed severe mitral regurgitation (MR) with vegetation on both mitral leaflets (A2 and P3) (Fig. 1a, b). Contrast-enhanced CT showed that the mediastinum and right thoracic cavity were filled with a massive hematoma (Fig. 1d, e).
case_images: Transesophageal echocardiography (TEE) reveals the prosthetic valve partial detachment and a false lumen posterior side of left atrium, where blood flows into
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case_images: PMC11734570_01_44215_2025_188_Fig2_HTML.jpg
case_images: Fig2
case_images: TEE showed a false lumen in the posterior aspect of the left atrium, and instability of the valve annular and left atrial dissection was diagnosed (Fig. 2). To manage the prosthetic valve detachment and concerns regarding rebleeding from the false lumen, we planned to perform redo MVR with a median sternotomy.
case_images: Intraoperative findings. a Upon removing the prosthetic valve and observing the mitral valve, a tear is observed in the mitral annulus at 3 o'clock, forming an entry. b The entry point was observed on the outer side of the prosthetic valve and the pledget (blue circle and blue arrow). c, d The valve annulus is fragile, and we performed annular reconstruction with a bovine pericardial patch from 2 o'clock to 6 o'clock to cover the tear and reinforce the valve annulus. The deepest region was sutured into the left ventricular myocardium with a gentle tension and a close suture. Valve sutures are placed in the bovine pericardium and intact annulus, and MVR is performed using Epic mitral valve 27 mm (Abbott Laboratories, Green Oaks, IL, USA). e The schema demonstrates the bioprosthetic mitral valve with the annular reconstruction using bovine pericardium
case_images: 44215_2025_188_Fig3_HTML.jpg
case_images: PMC11734570_01_44215_2025_188_Fig3_HTML.jpg
case_images: Fig3
case_images: Valve sutures were placed in the bovine pericardium and intact annulus, and MVR was performed using Epic mitral valve 27 mm (Fig. 3).