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Prosthetic Valve Obstruction — EECC MCQ

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ModerateValvular Heart DiseaseProsthetic Valve ObstructionEECC

A 68-year-old woman with a metallic aortic valve click presents with new-onset exertional dyspnoea. Echocardiography shows elevated transprosthetic gradients (mean gradient 35 mmHg, previously 15 mmHg at baseline). Fluoroscopy reveals restricted leaflet motion in one disc of her bileaflet mechanical valve. What is the most likely diagnosis?

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Correct answer: A — Prosthetic valve obstruction — either pannus ingrowth or thrombus requiring differentiation with TOE and CT

A significant increase in transprosthetic gradients from baseline, combined with restricted leaflet motion on fluoroscopy, indicates prosthetic valve obstruction. The two main causes are: (1) pannus ingrowth (fibrous tissue overgrowth, typically gradual onset) and (2) valve thrombosis (may be acute or subacute). TOE and cardiac CT can help differentiate these: thrombus appears as a soft tissue mass with mobility, while pannus is echodense and fixed. This distinction is critical because valve thrombosis may respond to anticoagulation intensification or thrombolysis, whereas pannus requires surgical intervention. The 2025 ESC VHD Guidelines recommend TOE and/or CT for evaluation of suspected prosthetic valve dysfunction.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease