Reoperation for complete posterior annular detachment and rocking motion of a prosthetic mitral valve after infective endocarditis

A 67-year-old female patient with a history of mechanical mitral and aortic valve replacement developed Enterococcus faecalis Prosthetic valve endocarditis (PVE). In this patient, who had negative serial blood cultures and had completed an eight-week course of intravenous antibiotic therapy with discharge planned, acute pulmonary edema developed unexpectedly. Transesophageal Echocardiography (TEE), Cinefluoroscopy, and intraoperative findings revealed complete detachment of the posterior mitral annulus, severe paravalvular regurgitation, and pronounced rocking motion of the prosthetic mitral valve. Additionally, moderate-to-severe functional tricuspid regurgitation was identified. An urgent mitral valve replacement using a bioprosthesis was performed in conjunction with tricuspid valve repair. The postoperative recovery was uneventful. Complete posterior annular detachment of the prosthetic mitral valve and pronounced rocking motion following prosthetic mitral valve endocarditis is an extremely rare mechanical complication. These complications, which are rarely observed after mitral PVE, may lead to acute heart failure and circulatory collapse and pose life-threatening risks. We report a rare case of successful revision surgery in a patient who developed paravalvular leak (PVL), posterior annular detachment, and rocking motion of a prosthetic mitral valve following infective endocarditis caused by Enterococcus faecalis .