Separation anxiety: Extreme dehiscence of a mitral annuloplasty ring

Echocardiography. 2019 Jun;36(6):1219-1221. doi: 10.1111/echo.14359. Epub 2019 May 13.


We report a patient admitted with acute pulmonary edema 3 months after mitral valve repair, with no history of inter-current febrile illness. Transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) and an abnormally positioned annuloplasty ring, suggestive of dehiscence. The extreme extent of ring dehiscence was visualized on 3-dimensional TEE (3D), with near-complete separation of the ring. Strept.Mitis and Cristatus were isolated from the ring following redo mitral valve surgery, confirming endocarditis as the mechanism for dehiscence. This report highlights the additive role and superior ability of 3D TEE in the identification and anatomic delineation of mitral ring dehiscence.

Keywords: dehiscence; mitral annuloplasty; mitral valve repair; transesophageal echocardiography.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Echocardiography, Three-Dimensional / methods*
  • Echocardiography, Transesophageal / methods*
  • Endocarditis / complications*
  • Endocarditis / diagnostic imaging
  • Endocarditis / surgery
  • Heart Valve Prosthesis
  • Humans
  • Male
  • Mitral Valve / diagnostic imaging*
  • Mitral Valve / surgery
  • Mitral Valve Annuloplasty*
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / surgery
  • Reoperation / methods
  • Surgical Wound Dehiscence / complications*
  • Surgical Wound Dehiscence / diagnostic imaging
  • Surgical Wound Dehiscence / surgery