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

Abstract

To determine the value of transesophageal ultrasound in the assessment of cardiac valve prostheses, 14 patients with clinically suspected mitral prosthesis malfunction were studied by transthoracic and transesophageal two-dimensional imaging as well as by color Doppler flow velocity mapping (color Doppler). Patients underwent left ventricular angiography (n = 13), surgery (n =11), or both angiography and surgery (n = 10). Nine patients had only mitral valve replacement, four patients had both mitral and aortic valve replacement, and one patient had mitral, aortic, and tricuspid valve replacement. There were 16 biological and four mechanical prostheses. The degree of mitral regurgitation was graded by both transthoracic and transesophageal color Doppler according to the area of the regurgitant jet visualized and was compared with a three-point classification of mitral regurgitation by left ventricular angiography judged by observers blinded to the echocardiographic results. All transesophageal studies were performed without complication and were well tolerated. The pathological morphology of the mitral prosthesis was additionally or more clearly visualized by transesophageal twodimensional imaging and subsequently proven at surgery in three patients with flail leaflets and one patient with a vegetation compared with images obtained by the transthoracic approach. Valvular regurgitation was graded by the transthoracic approach as absent in four patients, mild in two patients, moderate in five patients, and severe in only three patients. The transesophageal assessment showed absence of mitral regurgitation in two patients, moderate regurgitation in two patients, and severe regurgitation in 10 patients. Left ventricular angiography done in 13 of the 14 patients revealed no regurgitation in two patients, mild regurgitation in one patient, moderate regurgitation in one patient, and severe mitral regurgitation in nine patients. This corresponded to the grading by transesophageal echocardiography in 12 of the 13 patients with the 13th patient graded as mild regurgitation by angiography and moderate regurgitation by transesophageal echocardiography. We conclude that in patients with biological mitral prosthesis malfunction, transesophageal two-dimensional imaging, as well as color Doppler, can provide reliable diagnostic information beyond that available from the transthoracic approach with the degree of mitral regurgitation corresponding to that found on left ventricular angiography. (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...

Diagnosis and Management of Infective Endocarditis and Its Complications

“…26,29 -31 Also, prosthetic valvular insufficiency is much better defined on TEE, in which valve structures do not interfere with the Doppler signal. 32 The sensitivity of TEE can be further improved by imaging in Ն2 planes, because incremental planes decrease the number of false-negative studies and improve the definition of vegetation extent and mobility. 28 The excellent performance of TEE makes it the method of choice in the diagnosis of IE in patients who are difficult to image, in possible prosthetic-valve IE, in patients with intermediate or high clinical suspicion of IE, and in those patients with a high risk for IE-related complications (Table 4).…”

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] It decreased to 5Ϯ3 mmHg (Pϭ. 000) soon after T and to 4Ϯ2 mmHg (Pϭ0.000 versus baseline, PϭNS versus end of T infusion) at 24 hours.…”

“…[17][18][19][20][21][22][23] Since the introduction of TEE, ultrasound imaging has become the most used test in case of prosthesis dysfunction. This change happened without convincing scientific evidence of the superiority of 1 technique over the other.…”

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“…[10][11][12][13] One reason is that the access of ultrasound to the heart from the esophagus is not restricted by lung tissue. Another reason is that the structures in the left atrium are readily assessed because of the close proximity of the esophagus and left atrium and the ability to scan this cardiac chamber freely from the esophageal transducer position.…”