Intermittent mitral prosthetic dysfunction. what interferes the valve closure?
Abstract Background Prosthetic valve dysfunction due to entrapment of the subvalvular apparatus is a rare condition, particularly when occurring as a delayed postoperative complication. Spontaneous papillary muscle rupture in the absence of an ischemic event is also uncommon. The simultaneous presen...
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BMC
2025-07-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-025-03521-8 |
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| author | Pere Pericas Ronald Morales Murillo Marta Noris Mora Francisco Gual-Capllonch José Ignacio Sáez de Ibarra Vicente Peral Disdier |
| author_facet | Pere Pericas Ronald Morales Murillo Marta Noris Mora Francisco Gual-Capllonch José Ignacio Sáez de Ibarra Vicente Peral Disdier |
| author_sort | Pere Pericas |
| collection | DOAJ |
| description | Abstract Background Prosthetic valve dysfunction due to entrapment of the subvalvular apparatus is a rare condition, particularly when occurring as a delayed postoperative complication. Spontaneous papillary muscle rupture in the absence of an ischemic event is also uncommon. The simultaneous presence of both conditions renders this case of intermittent symptomatic mitral regurgitation exceptional. Case presentation We present the case of a 72-year-old woman with a history of rheumatic heart disease and a mechanical mitral valve prosthesis. Although the initial postoperative course was uneventful, she developed rapidly progressive heart failure symptoms two years after surgery, secondary to newly onset severe mitral regurgitation. Transesophageal echocardiography was crucial in elucidating the underlying mechanism, revealing a ventricular mass intermittently interfering with the proper closure of the mechanical prosthesis. The main differential diagnoses regarding the origin of the mass included: remnants of the subvalvular apparatus, vegetation, thrombotic material and pannus formation. Given the clinical deterioration, surgical intervention was considered necessary despite the lack of precise knowledge regarding the nature of mass. Surgical exploration confirmed the rupture of the subvalvular apparatus involving the anterolateral papillary muscle as the underlying cause of the prosthetic dysfunction. Excision of the ruptured chordae tendineae and residual papillary muscle was performed with a favorable outcome and no complications. Conclusions This case illustrates a rare cause of late prosthetic mitral valve dysfunction: the entrapment of the subvalvular apparatus due to spontaneous rupture of the papillary muscle. Transesophageal echocardiography proved highly valuable in understanding the mechanism of dysfunction; however, surgical exploration ultimately established the definitive diagnosis and facilitated the correction of the issue. |
| format | Article |
| id | doaj-art-caf3fc671ccf4f10b3bd865fbcf19ed8 |
| institution | DOAJ |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-caf3fc671ccf4f10b3bd865fbcf19ed82025-08-20T03:04:07ZengBMCJournal of Cardiothoracic Surgery1749-80902025-07-012011510.1186/s13019-025-03521-8Intermittent mitral prosthetic dysfunction. what interferes the valve closure?Pere Pericas0Ronald Morales Murillo1Marta Noris Mora2Francisco Gual-Capllonch3José Ignacio Sáez de Ibarra4Vicente Peral Disdier5Cardiology Department, Hospital Universitari Son EspasesCardiology Department, Hospital Universitari Son EspasesCardiology Department, Hospital Universitari Son EspasesCardiology Department, Hospital Universitari Son EspasesCardiac Surgery Department, Hospital Universitari Son EspasesCardiology Department, Hospital Universitari Son EspasesAbstract Background Prosthetic valve dysfunction due to entrapment of the subvalvular apparatus is a rare condition, particularly when occurring as a delayed postoperative complication. Spontaneous papillary muscle rupture in the absence of an ischemic event is also uncommon. The simultaneous presence of both conditions renders this case of intermittent symptomatic mitral regurgitation exceptional. Case presentation We present the case of a 72-year-old woman with a history of rheumatic heart disease and a mechanical mitral valve prosthesis. Although the initial postoperative course was uneventful, she developed rapidly progressive heart failure symptoms two years after surgery, secondary to newly onset severe mitral regurgitation. Transesophageal echocardiography was crucial in elucidating the underlying mechanism, revealing a ventricular mass intermittently interfering with the proper closure of the mechanical prosthesis. The main differential diagnoses regarding the origin of the mass included: remnants of the subvalvular apparatus, vegetation, thrombotic material and pannus formation. Given the clinical deterioration, surgical intervention was considered necessary despite the lack of precise knowledge regarding the nature of mass. Surgical exploration confirmed the rupture of the subvalvular apparatus involving the anterolateral papillary muscle as the underlying cause of the prosthetic dysfunction. Excision of the ruptured chordae tendineae and residual papillary muscle was performed with a favorable outcome and no complications. Conclusions This case illustrates a rare cause of late prosthetic mitral valve dysfunction: the entrapment of the subvalvular apparatus due to spontaneous rupture of the papillary muscle. Transesophageal echocardiography proved highly valuable in understanding the mechanism of dysfunction; however, surgical exploration ultimately established the definitive diagnosis and facilitated the correction of the issue.https://doi.org/10.1186/s13019-025-03521-8Prosthetic valve dysfunctionIntermittent mitral regurgitationPapillary muscle ruptureSubvalvular apparatus entrapment |
| spellingShingle | Pere Pericas Ronald Morales Murillo Marta Noris Mora Francisco Gual-Capllonch José Ignacio Sáez de Ibarra Vicente Peral Disdier Intermittent mitral prosthetic dysfunction. what interferes the valve closure? Journal of Cardiothoracic Surgery Prosthetic valve dysfunction Intermittent mitral regurgitation Papillary muscle rupture Subvalvular apparatus entrapment |
| title | Intermittent mitral prosthetic dysfunction. what interferes the valve closure? |
| title_full | Intermittent mitral prosthetic dysfunction. what interferes the valve closure? |
| title_fullStr | Intermittent mitral prosthetic dysfunction. what interferes the valve closure? |
| title_full_unstemmed | Intermittent mitral prosthetic dysfunction. what interferes the valve closure? |
| title_short | Intermittent mitral prosthetic dysfunction. what interferes the valve closure? |
| title_sort | intermittent mitral prosthetic dysfunction what interferes the valve closure |
| topic | Prosthetic valve dysfunction Intermittent mitral regurgitation Papillary muscle rupture Subvalvular apparatus entrapment |
| url | https://doi.org/10.1186/s13019-025-03521-8 |
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