Intermittent Trapping of a Tilting-Disc Mitral Prosthesis

A 57-year-old woman presented to our emergency room complaining of palpitations and crescent dyspnea. She had carried a tilting-disk mitral valve prosthesis since 1985.The ECG showed atrial tachycardia with 2:1 conduction (Figure 1). Her arterial pressure was 75/50 mm Hg, but signs of hypoperfusion were not apparent. On heart auscultation, prosthetic clicks were erratically audible. Transthoracic and transesophageal echocardiograms were performed (Figure 2A). They demonstrated that the valve opened once between 3 and 4 beats (Movies …