TEE images of loculated pericardial effusion after mitral valve replacement

Loculated pericardial effusion after mitral valve replacement. A patient developed signs and symptoms of cardiac tamponade in the ICU on the evening after mitral valve replacement. Emergency bedside TEE revealed a loculated hemorrhagic pericardial effusion (PE) adjacent to the lateral and posterior inferior walls of the left ventricle (LV) in the TEE mid-esophageal mitral valve commissural view at a multiplane angle of 31 degrees (left panel) and in the TEE transgastric view at a multiplane angle of 13 degrees (right panel). The loculated hemorrhagic PE caused compression of the left atrium (LA) and left ventricle (LV). On mediastinal re-exploration, the loculated PE was found to be caused by bleeding from suture line at the posterior mitral valve annulus.