Near Total Eclipse of the Aortic Valve: An Echocardiographic Penumbra Caused by a Mechanical Mitral Valve Prosthesis and Its Clinical Implications

b u l 47-YEAR-OLD woman with severe mitral stenosis resulting from chronic rheumatic disease, massive calcification of he posterior mitral annulus and subvalvular structures, and less rominent calcification of the anterior mitral annulus underwent a itral valve replacement with a 27-mm ATS bileaflet mechanical alve (ATS Medical Inc, Minneapolis, MN) after extensive deridement and patch reconstruction of the annulus using bovine ericardium. A transesophageal echocardiogram conducted after eparation from cardiopulmonary bypass revealed normal mitral alve prosthesis function, a minor posterior perivalvular leak, and bsence of aortic regurgitation in the conventional 5-chamber and ong-axis views of the aortic valve using Doppler color flow apping. Despite the apparent success of the surgical procedure,