Mechanical prosthetic valve dysfunction causing pulsus alternans leading to intermittent electromechanical dissociation: a case report and literature review

We describe a case of electromechanical dissociation (EMD) in a 62-year-old female patient following insertion of a Medtronic Hall mitral valve prosthesis. She initially developed pulsus alternans which led, over a few hours, to intermittent electromechanical dissociation. Clinical and echocardiographic findings are described. Emergency surgical intervention revealed a piece of chorda wedged between the disc occluder and the valve ring. This case illustrates clinical and Doppler echocardiographic features associated with a rare presentation of an unusual perioperative complication of prosthetic mitral valve dysfunction. We have also included a brief review of related literature.