A 32-year-old female underwent mitral valve replacement with total chordal preservation (Miki's technique) using 26mm (1M) Starr-Edward prosthesis (SEP) in 1988. The patient was in NYHA class-I until 2001. She progressed to NYHA class-III with paroxysmal nocturnal dyspnoea. Transthoracic echocardiogram showed increased prosthetic valve gradient, and cardiac catheterization confirmed the findings. Intraoperatively, the poppet movement in the cage was found to be restricted due to the preserved subvalvular apparatus entrapping the poppet inside the prosthetic valve cage.
J. G. Akbari, Dr. Praveen Varma, Gadhinglajkar, S. V., and Neelakandhan, K. S., “Late Entrapment of Ball and Cage Valve in Mitral Position”, Asian Cardiovascular and Thoracic Annals, vol. 14, no. 1, pp. e1-e3, 2006.