It was severe. I'm unsure of pressure gradients, but to put it in perspective his Inspiris was 23mm, and his On-X is a 27/29. His surgeon here was able to place a suction tube between his native tissue and the valve ring easily. The leak was destroying his RBCs and causing the symptoms that he had before his surgery, only worse. Kind of scary when I think too much about it.Hi @LoveMyBraveHeart Sorry to read Mathias's valve deteriorated so soon after it was implanted. I see you wrote he had patient prosthesis mismatch - do you know how bad that was, ie moderate or severe, and what were his pressure gradients ? I guess they worked out he had PPM because of what showed on a post surgery echocardiogram ?