AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The echo shows A2 and A3 prolapse of the mitral valve with a LVEF 50-60%. The MR is eccentrically directed and is severe. Mild to moderate pulmonary regurgitation is also present. After the mitral valve replacement a leak is present in the anterolateral aspect of the mitral valve. The leak is mild and borders on moderate.
O'Rourke looked at small or trivial periprosthetic leak (PPL) in the aortic and mitral valve position and found an incidence of PPL of 22.6% for the mitral valve. As these patients were followed with TTE postoperatively, he found that the PPL resolved or remained unchanged in the vast majority of patients. Older age, smaller body size, degenerative valve disease, or the use of a bioprosthetic valve increased the risk of a PPL. 1 patient (0.9%) required reoperation for a PPL.
The natural history of small or trivial PPL in two other studies indicated that small or trivial PPL does not progress. Patients with small or trivial PPL had either no change or resolution of the PPL on followup.
When a PPL does occur it most likely is going to occur in the anterolateral or the posteromedial aspect of the mtiral valve annulus which may indicate that these areas are more techinically demanding areas of the mitral valve.
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Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography
Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up.
Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography.
Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study