Unpredictable Mechanical Mitral Valve Leaflet Motion in a Patient With Continuous-Flow LVAD

Abstract

Background: Patients with a pre-existing mechanical mitral valve (MV) who undergo left ventricular assist device (LVAD) implantation pose unique challenges owing to interactions between the device and valve. Case summary: A 56-year-old man with a history of mechanical MV replacement and multiple interventions underwent LVAD implantation. After LVAD, the mechanical MV exhibited dynamic changes of leaflet mobility, from both stuck open to both moving freely. Despite these abnormalities, there was no clinically significant mitral regurgitation or hemodynamic impact. The patient was managed without surgery or thrombolytics and experienced no adverse clinical consequences related to mechanical MV dysfunction. Discussion: This case highlights the dynamic behavior of a mechanical MV after LVAD implantation, with variable leaflet positioning without significant mitral regurgitation or thromboembolic complications. Take-home messages: The interaction between LVADs and mechanical valves can result in unexpected alterations in valve function and intracardiac hemodynamics, underscoring the need for individualized care. In select cases, conservative management may be appropriate.