Artifact Mimicking Mechanical Valve Dysfunction on Intraoperative Transesophageal Echocardiography Following Redo Mitral Valve Replacement

Intraoperative transesophageal echocardiography (TEE) is vital for assessing prosthetic valve function, but imaging artifacts can lead to misdiagnosis. We describe a case of a 54-year-old man who underwent redo mitral valve replacement with a mechanical prosthesis, in which intraoperative TEE suggested prosthetic leaflet immobility. This prompted surgical re-exploration, which revealed normal valve function. Despite resection of posterior leaflet remnants that may have caused leaflet immobility, the abnormal findings persisted on TEE but were ultimately shown to be artifacts on intraoperative fluoroscopy. This case highlights the potential for TEE artifacts to mimic mechanical valve dysfunction. Multimodal imaging is critical for accurate diagnosis and avoiding unnecessary re-intervention.