Now you see it, now you don't: 3D echocardiographic evaluation of a prosthetic aortic valve

摘要

A 78-YEAR-OLD WOMAN with a previously implanted mechanical bileaflet aortic valve replacement (AVR) in 2001 (19 mm; St. Jude Medical, St. Paul, MN) presented to an outside hospital with a hip fracture, which was repaired surgically via a total hip arthroplasty. Before her hip fracture, the patient had good functional capacity and was able to walk as far as she liked without any limitations. Her medical history was significant for hypertension, hypothyroidism, and recently diagnosed chronic lymphoma. Postoperatively, she was found to be hypoxic, with a significant oxygen requirement and radiologic findings consistent with pulmonary edema. A trans-thoracic echocardiogram (TTE) at the outside hospital reported severe stenosis of her mechanical aortic valve (valve area 0.6 cm2) with normal left ventricular (LV) systolic function (estimated ejection fraction of 65%). She was transferred to the authors' institution for further work-up and management.