Acute dysfunction of tilting disc valve after mitral valve replacement

Acute prosthetic valve dysfunction is a serious complication following valve replacement surgeries. Extrinsic prosthetic valve obstructions usually limit valve function, thus affecting cardiac output. We report a case of double valve replacements with mono leaflet tilting disc valves and tricuspid repair. Patient had normal prosthetic valve function in immediate post-operative period. She developed episodes of pulseless electrical activity with low cardiac output on the first post-operative day. Patient was re-explored with suspicion of valve dysfunction and pericardial effusion. Transesophageal echocardiogram showed intermittent extrinsic obstruction of mitral prosthesis. We observe that acute prosthetic dysfunction can present with unexplained pulse less electrical activity and can be confirmed with transesophageal echocardiography. Electro mechanical dissociation and low cardiac output following prosthetic valve replacement may be due to acute prosthetic dysfunction. A high index of suspicion and early intervention can be vital in such patients.