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Image challenge
An abnormal chamber-like structure after mitral valve replacement
  1. Yu Kang1,
  2. Ritai Huang2,
  3. Ben He1
  1. 1 Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  2. 2 Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  1. Correspondence to Ben He, Department of cardiology, Renji hospital, School of medicine,Shanghai Jiaotong University, No. 1630 Dongfang Rd, Shanghai 20126 , China; heben{at}medmail.com.cn

Abstract

Clinical introduction A 59-year-old woman who underwent mitral valve replacement and tricuspid annuloplasty with the De Vega technique without a rigid ring 16 years ago for rheumatic mitral stenosis was referred to our hospital for aggressive dyspnoea and oedema of lower extremities refractory to diuretics. ECG showed atrial fibrillation. Transthoracic echocardiography reveal ed severe tricuspid regurgitation, preserved left and right ventricular systolic function, slightly elevated systolic pulmonary artery pressure and an abnormal chamber-like structure (see online supplementary video A). Hence, transoesophageal echocardiography (TE) was performed (figure 1, see online supplementary video B).

Supplementary video

Supplementary video

Figure 1
Figure 1

Mid-oesophageal four-chamber view of transoesophageal echocardiography.

Question What is the diagnosis of this abnormal chamber-like structure?

  1. Left atrial mass

  2. Localised pericardial effusion

  3. Left atrial dissection

  4. Hiatal hernia

  5. Coronary artery aneurysm

Question

  • Valve disease surgery
  • Echocardiography
  • Cardiac surgery
  • Caediac procedure and theraphy
  • Cardiac imaging and diagnostics

https://doi.org/10.1136/heartjnl-2016-311041

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    Footnotes

    • Contributors YK and RH contribute equally to the work. YK and RH collected patients data and prepared the manuscript. BH is the corresponding author and responsible for editing the manuscript.

    • Funding This work was supported by grants no. 81401411 from the National Nature Science Foundation of China, and nos. 14ZR1425200 and 16ZR1420600 from Nature Science Foundation of Shanghai.

    • Competing interests None declared.

    • Ethics approval Renji Hospital Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.