الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Mitral paravalvular leak (PVL) is a relatively infrequent yet serious complication associated with prosthetic valve implantation. Paravalvular leak is defined as blood flowing through a channel between the prosthetic valve sewing ring and cardiac chamber as a result of a lack of appropriate sealing.
The incidence of mitral PVL, including small non-significant jets, is estimated to be 7-17%. Most PVLs are asymptomatic and have a benign clinical course, however 1–5% of patients have serious clinical consequences.
Echocardiography is the gold standard imaging modality to establish the diagnosis and to identify the severity of paravalvular regurgitation. Successful imaging of the PVL can be challenging. Transthoracic echocardiography (TTE) is the initial approach that is commonly performed to be followed by transesophageal echocardiography (TEE) if there is clinical or echocardiographic suspicion. Real-time three-dimensional echocardiography has shown better diagnostic accuracy compared to two-dimensional (2D) imaging in the assessment of leaks particularly in patients with multiple defects. It allows a better delineation of the site, size and shape, making this modality the cornerstone and the gold standard for PVL evaluation.
This was a prospective study that enrolled 15 patients with severe mechanical mitral paravalvular leak presenting with clinical manifestations of heart failure and/or hemolytic anaemia and/or infective endocarditis.
Patients with history of oesophageal varices, strictures, tumours, coagulopathy, thrombocytopenia or active upper GIT bleeding were excluded from the study.
Two-dimensional transthoracic echocardiography was the initial tool for assessment of mitral prosthesis stability, detection of any rocking motion or vegetations and assessment of Doppler parameters of the prosthesis. Transesophageal echocardiography (TEE) was scheduled whenever there was clinical or echocardiographic suspicion of mitral paravalvular leak. Two dimensional and real-time three-dimensional TEE imaging were performed during the same session. Images were assessed offline and mitral paravalvular leaks were described in terms of their number, shape, size and localization.
Demographic and patients` clinical characteristics were collected. The coagulation profile of all studied cases and the workup of infective endocarditis and hemolytic anaemia in suspected cases were recorded.
The study included eleven males (73.3%) and four females (26.7%) with a mean age 49.80 ± 12.55 years. Ten patients (66.7%) underwent mechanical aortic and mitral valve replacement while 5 patients (33.3%) underwent mechanical mitral valve replacement only with mean duration 8.23 ± 5.32 years. Two patients (13.33%) presented with early mitral paravalvular leak, while 13 patients (86.67%) presented with late mitral paravalvular leak.
Heart failure NYHA class II - IV was the most common clinical presentation being present in 14 patients to be followed by hemolytic anaemia being present in 7 patients. Four patients presented with infective endocarditis and only one patient was asymptomatic and mitral paravalvular leak was detected accidently. Most of the patients presented with more than one clinical picture. Regarding the four patients who presented with infective endocarditis, their blood cultures showed Methicillin resistant Staphylococcus aureus (MRSA).