Intermittent electromechanical dissociation due to mechanical prosthetic valve dysfunction

We describe a patient who developed the rare hemodynamic phenomenon of inte rmittent electromechanical dissociation during normal sinus rhythm at about four months after mitral valve replacement with a Medtronic Hall prosthesi s, along with resuspension of the papillary muscles using Gore-Tex sutures. Echocardiographic examination confirmed the presence of a filamentous stru cture that could be either suture material, tissue tag or thrombus, and was entangling intermittently in the prosthesis. The patient recovered spontan eously after a three-week symptomatic period, with no subsequent evidence o f either electromechanical dissociation or the filamentous structure; norma l prosthetic valve function was restored. During a subsequent three-month f ollow up period, the patient was asymptomatic, with normal prosthetic valve function. The diagnostic and hemodynamic aspects of this case are discusse d.