Mechanical Flow Obstruction after Heart Transplantation Diagnosed by Tee

We report a case of mechanical flow obstruction after heart transplantation caused by a prominent left atrium suture with a "pursestring" effect. The diagnosis was achieved by transesophageal echocardiography. The mean transstenotic gradient was measured at 13 mm Hg. Because of the profound hemodynamic and multisystemic failure, no surgical correction was attempted. The postmortem examination confirmed the stenosis at the level of the left atrium.