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A 67 year old woman was successfully operated on for rheumatoid mitral stenosis, and a St Jude prosthetic mitral valve was replaced. Severe mitral stenosis, mild mitral regurgitation, and moderate tricuspid regurgitation was observed on transthoracic echocardiography before the operation. Transthoracic echocardiography on the fourth postoperative day revealed a colour flow convergence and Doppler flow; at first these findings were considered suspicious for prosthetic paravalvar regurgitation. Transoesophageal echocardiography was subsequently undertaken. At a scanning plane 115–125°, a strange halo sign was found in the middle of the left atrium on the proximal view. Colour Doppler imaging showed a isolated coloured halo image, and there was no connection between this image and left atrial wall or prosthetic mitral valve (below left; LA, left atrium). This coloured halo image disappeared at diastole and then reappeared at systole. Decremental rotation of the probe angle revealed a large interatrial aneurysm type II (below right, RA, right atrium; IAS, interatrial septum; TR, tricuspid regurgitation) and moderate tricuspid regurgitation, which was eccentrically positioned towards the aneurysmatic pouch. None of the paravalvar prosthetic mitral regurgitation was detected.
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