Regurgitant Flow of Mitral Valve Prostheses: An Intraoperative Transesophageal Echocardiographic Study

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…If a prosthetic MV is implanted, transesophageal echocardiography can detect technical problems such as paravalvular regurgitation or abnormal leaflet motion. Small, insignificant central or paravalvular leaks are commonly observed immediately after cardiopulmonary bypass, and should not be a cause for concern (930). It is possible to injure the left circumflex coronary artery or tether a cusp of the aortic valve with a suture placed in the mitral annulus.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Small, insignificant central and paravalvular leaks are commonly seen immediately after cardiopulmonary bypass and should not be a cause for concern. 930 …”

“…Small, insignificant central or paravalvular leaks are commonly observed immediately after cardiopulmonary bypass, and should not be a cause for concern. 930 It is possible to injure the left circumflex coronary artery or tether a cusp of the aortic valve with a suture placed in the mitral annulus. Therefore, assessment of LV function and examination of the aortic valve and adjacent structures should always be performed with transesophageal echocardiography after MV surgery.…”

Perivalvular leakage after termination of cardiopulmonary bypass procedure

“…Whether to repair minimal PVR (jet area <3.0cm 2) found at the time of surgery is controversial [11,12]. PVR is relatively common and the correct clinical response somewhat uncertain.…”

“…PVR is relatively common and the correct clinical response somewhat uncertain. Most authorities believe that small leaks are best left alone and should not undergo further surgery [12], but there are no definitive studies in this area [11]. Lange et al reported that clinically significant PVR should be suspected if the maximum jet length exceeds 3.0cm [10].…”