Prosthetic mitral valve thrombosis, malfunction, and paroxysmal mitral regurgitation.

Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28-year-old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.

Percutaneous Balloon Dilation of Discrete Subaortic Stenosis: A Futile Exercise.

Discrete subaortic stenosis (DSS) is a progressive obstruction of left ventricular outflow tract (LVOT) resulting in the development of aortic regurgitation in its natural course. Hence, early intervention is recommended. Percutaneous balloon dilation of DSS has been reported and can substantially reduce LVOT pressure gradient. The response to balloon dilation of DSS is transient and may complicate with chordal or papillary muscle rupture. Hence, balloon dilation of DSS should be discouraged.

Hematological dyspnea: A rare cause with gratifying recovery.

A 17-year-old female was referred for evaluation of fever of two-month duration with acute onset of dyspnea since 1 week. Clinical examination revealed tachycardia, tachypnea, elevated jugular venous pressure, bilateral basal crepitations with normal heart sounds, and no murmur. Chest X-ray showed infiltrates in bilateral lung fields. Echocardiography revealed obliteration of biventricular apices along with layered thrombus over the left ventricular endocardium. Doppler studies elicited restrictive physiology with mild mitral and tricuspid regurgitation. Complete hemogram revealed hypereosinophilia with eosinophilic count of 7.4 × 109/L. All secondary causes of elevated eosinophil count were excluded. The patient was started on steroids and anticoagulation. Serial echocardiograms showed clearing of the thrombus with marked symptomatic improvement. We highlight a case of idiopathic hypereosinophilic syndrome with classic cardiac (Loeffler endocarditis) and pulmonary manifestations and prompt recovery with steroids and anticoagulation. .

Pulsatile neck mass: A rare cause.

A 20-year-old female presented with a pulsatile neck mass. On evaluation, she was found to have right cervical aortic arch, which is a rare anomaly. We highlight the conventional and Computed tomography angiography features of this vascular anomaly.