Paravalvular mitral valve leakage presenting as congestive heart failure, missed by TTE but diagnosed by TEE: a case report

BACKGROUND Diagnosis of prosthetic valve leakage by the transthoracic echocardiogram (TTE) technique is more difficult. These limitations are diminished with the use of transesophageal echocardiogram (TEE) techniques. CASE REPORT A 71 year old Caucasian male presented with symptoms and signs of congestive heart failure. Past medical history included a bio-prosthetic mitral valve replacement for severe mitral regurgitation. TTE showed possible mitral regurgitation. As the TTE did not correlate with the finding of a high E-velocity, a TEE was performed, which showed a significant paravalvular leak of moderate severity around the bio-prosthetic mitral valve. CONCLUSION There should be a high degree of suspicion to diagnose a paravalvular leak.