Transesophageal Doppler Echocardiographic Assessment of Left-Sided Bioprosthetic Regurgitation: Comparison with the Transthoracic Approach

Abstract

The clinical value of transesophageal and transthoracic ultrasound examinations in the assessment of bioprosthetic valve dysfunction was compared in 21 patients (12 with mitral and 9 with aortic bioprosthetic regurgitation). Angiography was performed in 16 patients, and pathological morphology of valve malfunction was confirmed by surgery or autopsy. At the mitral position, the severity of regurgitation and pathomorphology determined by transesophageal Doppler echocardiography corresponded well to angiographic grading and surgical or autopsy findings, respectively. The transthoracic imaging underestimated angiographic regurgitation in 25% of patients and detected flail motion of valve leaflets in 6 of 9 patients with tom cusps. At the aortic position, both transesophageal and transthoracic approaches were of similar value in characterizing the possible cause of regurgitation, but the transthoracic Doppler approach provided better assessment of the degree of regurgitation. The study indicates that transesophageal echocardiography and Doppler color flow imaging are superior to the transthoracic approach in assessing the severity and cause of bioprosthetic mitral regurgitation but the transthoracic approach remains useful in the evaluation of aortic bioprosthetic valve dysfunction.