Early severe paravalvular leak following mitral valve replacement with a prosthetic mechanical bileaflet valve

Abstract: A middle-aged woman developed severe breathlessness soon after mitral valve replacement for rheumatic heart disease with severe mitral stenosis and moderate mitral regurgitation. Echocardiography (two-dimensional and transesophageal) revealed a severe paravalvular leak into the left atrium between the mechanical bileaflet mitral valve and the aortic annulus. The patient was stabilized with intravenous nitroglycerin and torsemide, and the heart rate was controlled with tablet metoprolol. The patient was successfully treated with a redo surgery using a larger mechanical mitral bileaflet valve (size 29 mm) and interrupted sutures. A 25-mm mechanical bileaflet valve was used during index surgery.