Prosthetic mitral valve obstruction: role of real-time three-dimensional transesophageal echocardiography in diagnosis.

Acute prosthetic valve thrombosis is a potentially serious complication with an incidence as high as 6% per patient-year for prostheses in the mitral position. Accurate diagnosis of the degree of obstruction and differentiation of pannus versus thrombus is critical in determination of the best mode of therapy. We discuss a case of a patient with multiple comorbidities who presented with mechanical mitral valve obstruction where both transthoracic and two-dimensional transesophageal echocardiography (TEE) were limited in making an accurate diagnosis regarding the mechanism of obstruction.