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Perivalvular leak is a serious, yet uncommon complication of prosthetic mitral valve replacement. 1-3% of these patients require re-operation due to development of symptoms of heart failure and/or hemolysis. We present a patient who returned to the hospital in fulminant heart failure 4 months after an MVR due to a perivalvular leak not caused by endocarditis. We discuss the typical pathology and implications of a prosthetic valve dehiscence and the challenges these patients present in thedoi:10.15761/gapm.1000161 fatcat:rdpa72knxjbqld6wfapux66kjm