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Figure 1. A 78-year-old woman presented with marked dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Eight years earlier, she had received a bioprosthetic mitral valve because of mixed mitral-valve disease. Physical examination showed an elevation in jugular venous pressure, an increased intensity of the first heart sound, a holodiastolic mitral rumble with pre-systolic accentuation, and hepatomegaly. Two-dimensional echocardiography (Panel A) showed dense calcification of the mitral valve (arrow). Doppler ultrasonography (Panel B) revealed a high mitral gradient (mean, 20 mm Hg) and a markedly decreased functional valve area (0.5 cm2). An invasive hemodynamic study (Panel C) also showed a . . . [Full Text of this Article] |
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