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This 30 year old woman had undergone a mitral valve replacement with a bileaflet prosthesis one year previously. Postoperatively she had been well until she presented with a two week history of shortness of breath and an episode of paroxysmal nocturnal dyspnoea. During this time her anticoagulation had been subtherapeutic. A transoesophageal echocardiogram (TOE) was performed to assess the prosthetic mitral valve. The TOE showed a stuck leaflet caused by thrombus with flow through only one side of the prosthesis.
Continuous wave Doppler through the valve gave an elevated peak forward flow velocity of 3 m/s. After a period of adequate anticoagulation the valve was unchanged and the patient underwent redo mitral valve replacement.