Intraoperative transesophageal echocardiographic assessment of acute prosthetic aortic valve regurgitation after mitral valve replacement: value of the deep transgastric long-axis view.

The transesophageal echocardiographic assessment of prosthetic aortic valve function is made more difficult by the presence of a mechanical mitral valve prosthesis because echocardiographic views conventionally used to assess the aortic valve function are obscured by acoustic shadowing and artifacts. We report the use of intraoperative transesophageal echocardiography in a patient who developed severe prosthetic aortic valve regurgitation after implantation of a mechanical mitral valve, in whom conventional multiplane midesophageal views failed to reveal aortic regurgitation owing to acoustic shadowing and artifacts from the prosthetic mitral valve. We report the value of the deep transgastric long-axis view of the aortic valve that provided an unobstructed view of the left-ventricular outflow tract, and clearly demonstrated severe aortic regurgitation as a result of interference with the prosthetic aortic valve mechanism by the implanted mitral valve prosthesis. This case also emphasizes the importance of a comprehensive intraoperative transesophageal examination, including that of surrounding structures, to detect iatrogenic complications during mitral valve replacement.