Rocking motion of prosthetic aortic valve on cine fluoroscopy– a summon of catastrophe

Abstract

Dehiscence of mechanical prosthetic valve is rare complication reported in 0.1–1.3% of patients undergoing valve replacement with infective endocarditis being the commonest cause.1,2 In spite of rapid diagnosis and prompt initiation of treatment, outcome is often poor due to fulminant course of the disease. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are used to diagnose valvular dehiscence. Cine-fluoroscopy can be useful in cases when TEE is not available or not feasible due to hemodynamic instability. Abnormal rocking motion of the prosthetic valve is characteristic of dehiscence on cine-fluoroscopy. We report a patient who presented with near complete dehiscence of aortic mechanical prosthetic valve, diagnosed on TTE and confirmed with cine-fluoroscopy. The patient succumbed before he could be operated despite aggressive medical management. The case is being reported because of the rarity of such extensive valve dehiscence allowing any opportunity for imaging.

Keywords

• Prosthetic valve
• Cine fluoroscopy
• Rocking motion
• Dehiscence
• Infective endocarditis