skip to main content

Trimetazidine in Refractory Angina — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardCoronary Artery DiseaseTrimetazidine in Refractory AnginaEECC

A patient with a mechanical mitral prosthesis develops transfusion-dependent haemolysis. TOE shows a crescentic paravalvular regurgitant jet occupying 12% of the sewing-ring circumference; the prosthesis itself moves normally and blood cultures are negative. Surgical risk is prohibitive. What should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Transcatheter paravalvular-leak closure at an experienced valve centre

A clinically important paravalvular leak can cause severe haemolysis despite normally functioning mechanical leaflets. In a patient at prohibitive redo-surgical risk with suitable anatomy and no active infection, transcatheter paravalvular-leak closure is a specialist option. Valve-in-valve implantation cannot be performed inside a mechanical prosthesis. Balloon valvuloplasty and transmitral commissurotomy do not close the paravalvular channel, while long-term rifampicin has no role when cultures are negative and there is no evidence of endocarditis.

Reference: 2025 ESC/EACTS Guidelines for valvular heart disease. https://academic.oup.com/eurheartj/article/46/44/4635/8234488