# Artifact Mimicking Mechanical Valve Dysfunction on Intraoperative Transesophageal Echocardiography Following Redo Mitral Valve Replacement

## TL;DR

A case shows how TEE imaging can create misleading artifacts resembling mechanical valve dysfunction, emphasizing the need for multimodal imaging to avoid unnecessary surgery.

## Contribution

Highlights a rare TEE artifact mimicking mechanical valve dysfunction after redo surgery, stressing the importance of multimodal imaging.

## Key findings

- TEE showed prosthetic leaflet immobility, leading to surgical re-exploration.
- Fluoroscopy confirmed the findings were artifacts, not actual valve dysfunction.
- Multimodal imaging is essential to prevent misdiagnosis and unnecessary interventions.

## Abstract

Intraoperative transesophageal echocardiography (TEE) is vital for assessing prosthetic valve function, but imaging artifacts can lead to misdiagnosis. We describe a case of a 54-year-old man who underwent redo mitral valve replacement with a mechanical prosthesis, in which intraoperative TEE suggested prosthetic leaflet immobility. This prompted surgical re-exploration, which revealed normal valve function. Despite resection of posterior leaflet remnants that may have caused leaflet immobility, the abnormal findings persisted on TEE but were ultimately shown to be artifacts on intraoperative fluoroscopy. This case highlights the potential for TEE artifacts to mimic mechanical valve dysfunction. Multimodal imaging is critical for accurate diagnosis and avoiding unnecessary re-intervention.