Prosthetic Mitral Valve on CXR

X-ray Quiz 10 – Discussion

X-ray chest taken after mitral valve replacement. Only the sewing ring of the tilting disc mitral prosthetic valve is visible. Three struts for holding the disc are also seen. The disc is not radio opaque and hence not visible. Left atrial enlargement is seen as double density on the right side and straightening of left border on left side. Sternal wires indicate post sternotomy state. Upper lobe vessels are prominent, possibly a residua of previous pulmonary venous hypertension. From the X-ray alone we are not sure whether there is paraprosthetic mitral regurgitation which is causing biatrial enlargement and pulmonary venous hypertension.

There could also be tricuspid regurgitation to account for significant right atrial enlargement. As the tracheal air column is seen well, the indentation on left side by a left sided aortic arch is clearly seen. Prosthetic valve can be identified as being in the mitral location by the position below the line joining the pulmonary bay to right cardiophrenic angle. Aortic prosthetic valve will be above that line.