Abstract
Paravalvular leak is a rare, challenging complication of prosthetic mitral valve replacement. Patients can be asymptomatic or develop symptoms of heart failure and/or hemolysis. Comprehensive echocardiographic imaging with transthoracic and real-time three-dimensional transesophageal echocardiography is key for characterization of the defect location, size, and shape. Re-do surgery or percutaneous techniques are the available definitive treatment options. We present a patient who returned to the hospital in heart failure and transfusion dependent hemolytic anaemia 3 months after a Mitral Valve Replacement due to a paravalvular leak not caused by endocarditis. This case is unique providing real-world short-term outcome of a conservatively managed severe prosthetic mitral paravalvular leak. We discuss the typical pathology and implications of a prosthetic valve dehiscence and the challenges in patient presentations. Multimodality imaging is utmost important for management decisions. We aim to highlight the importance of case-based decision through multidisciplinary team approach.