Detection of prosthetic mitral valve leak: A comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation

Abstract

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.

Defining structural heart disease in the adult patient: current scope, inherent challenges and future directions

“…Although long-term results follow valve replacement surgery are excellent, paravalvular leak (PVL) may be detected in up to 5% of the patients by contemporary echocardiographic imaging. 26,27 It results from incomplete apposition of the implanted ring to the native tissue and is often benign and asymptomatic. Symptoms can occur, however, due to large regurgitant volume or haemolysis.…”

Percutaneous Valvular Leak Repair

“…This is especially true of TEE, in which early studies have demonstrated it to be superior to transthoracic echocardiography (TTE) for the study of periprosthetic dehiscence [42,43]. Such superiority is most evident with mitral prosthesis, whereby the use of TTE poses significant limitations due to sonic shadow zones produced by the prosthesis itself.…”

Prosthetic heart valves: Types and echocardiographic evaluation

“…2). The prevalence of physiologic regurgitation across stented bioprosthetic valves is 19%-25% and 26%-30% for mitral and aortic positions, respectively [57,84,92]. The newer generation stentless valves are being used frequently due to their excellent hemodynamic profile.…”

“…The acoustic shadowing from prosthesis may lead to nonvisualization or underestimation of the severity of the regurgitation, especially with mechanical valves [88][89][90][91][92][93][94]. The transthoracic approach is better for the evaluation of aortic prosthetic valve regurgitation than the mitral prosthetic valve regurgitation because the prosthesis at aortic position does not interface in between the transducer and the regurgitant jet [77][78][79][80][81].…”