Doppler and echocardiographic features of normal and dysfunctioning bioprosthetic valves

Abstract

Echocardiographic and Doppler studies were performed on 183 clinically normal and 58 severely dysfunctioning bioprosthetic mitral, aortic and tricuspid valves. The valve dysfunction resulted from spontaneous cusp degeneration in 49 instances and from paravalvular regurgitation in 9. The pulsed Doppler study demonstrated regurgitant flow in 36 (92%) of 39 regurgitant valves and 8 (90%) of 9 paravalvular regurgitant valves. Diagnostic echocardiographic features were present in only 51 and 10% of the patients, respectively. Although the Doppler regurgitant jet was peripheral in seven of the nine patients with paravalvular regurgitation, it was not possible to differentiate these patients from those who had valve degeneration and cusp tear at the periphery of the valve ring. Eight patients presented with a musical holosystolic murmur of mitral insufficiency. In all eight there was a characteristic honking intonation on the audio signal and a striated shuddering appearance on the video Doppler signal. Ten stenotic mitral bioprosthetic valves (less than or equal to 1.1 cm2 valve orifice) were identified by Doppler study. Diagnostic echocardiographic features were present in only two of these patients. The Doppler-derived valve orifice dimension correlated well (r = 0.83) with cardiac catheterization values. Fourteen asymptomatic or minimally symptomatic patients had echocardiographically thickened mitral cusps (greater than or equal to 3 mm). These patients had a significantly (p less than 0.0001) smaller valve area as compared with normal control valves, and during 4 to 24 months of follow-up, five of these patients developed severe valve regurgitation or stenosis. Doppler ultrasound is more sensitive than echocardiography in diagnosing bioprosthetic valve stenosis and regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of Physical Examination and Noninvasive Tests in the Diagnosis of Degeneration of Porcine Bioprosthetic Valves in the Mitral Position

“…M-mode and 2-D echocardio grams showed an average thickness of 1.3 ± 0.5 mm (mean ± SD), range 1.0-2.5 mm. In our experience, an échocardiographie valve thickness of less than 3 mm is normal [3]. None of the patients showed any evidence of systolic fluttering of flail motion.…”

“…In our laboratory, the peak gradient across a normal por cine bioprosthetic valve in mitral position, measured by Doppler, is 9.9 ± 3.4 mm Hg (mean ± SD), and the normal porcine valve area, when in the mitral position, calculated by Doppler is 1.5 cm2 or greater. Only one control valve fell below this level [3]. That valve was 1.4 cm2.…”

“…Analysis by M-mode echocardiography [1], two-dimensional (2-D) echocardi ography [2], and cardiac Doppler studies [3] have been reported as means of identifying bioprosthetic valve degeneration. In addition, the frequency content of the bioprosthetic valve sounds [4], as well as echocardiogra phy may permit a recognition of subclinical degenera tion.…”

Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping in the evaluation of cardiac valve prostheses.

“…(Circulation 1988;78:848-855) TNhe potential value of transthoracic twoeven with advanced ultrasound equipment in obese dimensional and Doppler echocardiography and emphysematous patients, as well as in patients in the assessment of prosthetic heart valves with chest deformities and in the early postoperahas been well established. [1][2][3][4] However, accurate tive period. Even in apparently high-quality recorddiagnosis of prosthesis malfunction may be difficult ings, the ultrasound beam is attenuated by the material of most prostheses.5 This fact compro-…”

“…[1][2][3][4] 14), all of whom complained of increasing fatigue and shortness of breath. In two patients (patients 3 and 13) with positive blood cultures, the echocardiographic study was done to assess possible endocarditis.…”