# Untoward Long-Term Consequences of Misplaced and Restrictive Annuloplasty for Degenerative Mitral Regurgitation

## TL;DR

A patient with long-term mitral valve repair developed mitral stenosis, and advanced imaging techniques helped identify the cause.

## Contribution

Demonstrates the utility of multimodality imaging and exercise stress testing in diagnosing late complications of mitral valve repair.

## Key findings

- Exercise stress echocardiography revealed mitral stenosis in a patient with prior mitral valve repair.
- CT with motion correction and transesophageal echocardiography identified the misplaced prosthetic valve ring.
- Combined imaging and stress testing improved understanding of pathophysiology in long-term valve repair complications.

## Abstract

Mitral stenosis after mitral valve repair for degenerative mitral regurgitation is a poor prognostic factor, but there are few reports of long-term postoperative course.

A 73-year-old man who had undergone mitral valve repair 24 years ago visited our hospital with shortness of breath. Exercise stress echocardiography induced mitral stenosis. Multimodality imaging with computed tomography (CT) and transesophageal echocardiography were really useful in detecting the abnormal location of the prosthetic valve ring causing mitral stenosis.

Wide-coverage CT and image processing using a new motion correction algorithm has allowed the visualization of highly mobile structures and thereby enabled more accurate assessment from previous assessments.

The exercise stress test is useful in patients with discrepancies between symptoms, physical examination findings, and the examination results at rest. Morphologic evaluation of valve structures combined with CT and transesophageal echocardiography can provide a more detailed pathophysiologic assessment and understanding of causes.