No abstract

Postinfarction ventricular septal defect (PIVSD) is challenging in both diagnosis and management. Especially in case of percutaneous treatment, a comprehensive echocardiographic assessment is needed. Bidimensional echocardiography enables localization and quantifi cation of intracardiac shunting aiding occluder devices proper choosing and positioning. Nevertheless real time three‐dimensional (3D) echocardiography usage presents additional benefi ts, defi ning in details the site of rupture and the surrounding cardiac structures. By 3D transesophageal guidance, delivery maneuvers are optimized and inappropriate expansion or position of the implanted device can be accurately assessed. In conclusion, real time 3D echocardiography emerges as a valid and advanced tool in diagnosis and management of PIVSD.

Objectives:The aim of this study was to evaluate the hemodynamic performance of a sutureless bioprosthesis under high workload at mid-term follow-up. Methods:Thirty-two patients who underwent isolated aortic valve replacement with a Perceval sutureless bioprosthesis with a minimum follow-up of 1 year were enrolled in this study. S size prosthesis was deployed in 10 patients (31.3%), M size in 9 (28.1%), L size in 8 (25%) and XL size in 5 (15.6%). Effective orifice area (EOA), EOA index (EOAi), and transvalvular gradients were assessed at rest and during dobutamine stress echocardiography (DSE) a median of 19.5 months after surgery.Results: Dobutamine stress echocardiography (DSE) significantly increased heart rate, stroke volume, ejection fraction, and transvalvular gradients (peak gradient, 24.0 ± 7.6 vs 38.7 ± 13.6 mm Hg, P < .001; mean gradient, 12.6 ± 4.2 vs 19.8 ± 8.3, P < .001).When compared to baseline, estimated valve areas significantly increased at follow-up (EOA, 1.48 ± 0.46 vs 2.06 ± 0.67, P < .001; EOAi, 0.84 ± 0.26 vs 1.17 ± 0.37, P < .001).Mean percentage increase in EOAi was 40.3% ± 28.0%. S size prostheses had the highest increase in EOA1, but the difference was not significant (S 46.0% ± 27.5% vs M 45.4% ± 34.5% vs L 32.7% ± 26.4% vs XL 32.1% ± 20.5%, P = .66). Severe patientprosthesis mismatch (EOAi ≤ 0.65 cm 2 /m 2 ) was present at rest in 8 patients (25%), but only in one patient (3.1%) during DSE. Conclusions:The Perceval sutureless bioprosthesis demonstrated good hemodynamics at rest and under high workload. The significant increase in EOAi during DSE suggests the potential advantages of Perceval sutureless bioprostheses in case of small aortic annulus or when patient-prosthesis mismatch is anticipated. K E Y W O R D Saortic valve prosthesis, aortic valve replacement, dobutamine stress echocardiography, sutureless