Evaluation of Prosthetic Heart Valves by Transesophageal Echocardiography: Problems, Pitfalls, and Timing of Echocardiography

Abstract

Transesophageal echocardiography (TEE) is especially suitable for examination of prosthetic valves because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs. This article reviews normal and abnormal morphologic characteristics of prosthetic valves such as spontaneous echocontrast, microbubbles, strands, sutures, vegetations or thrombus. Doppler echocardiographic characteristics of normal and pathologic prosthetic valve function and the management of prosthetic valve pathology is discussed. Physicians taking care of patients with prosthetic valves should be familiar with the characteristics of normal and abnormally functioning prosthetic valves.

The Current Status of Fluoroscopy and Echocardiography in the Diagnosis of Prosthetic Valve Thrombosis—A Review Article

“…34 Because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs, a very detailed image can be obtained of the atrial side of the mitral valve prosthesis. 35 TEE has superior sensitivity and specificity for the diagnosis of mitral PVT because of echocardiography artifacts in the left atrium on TTE examination. TEE permits the quantitation of thrombus burden.…”

“…Vegetations and thrombus cannot be distinguished by echocardiography alone; the differential diagnosis of these sessile or pedunculated masses depends on the full clinical picture. 35 Vegetation is more likely in febrile patients and in the presence of symptoms and clinical signs of infective endocarditis but also in the presence of perivalvular destruction, leak, or abscess formation, 32 whereas thrombus is likely in a poorly anticoagulated patient. There may be further similarities between thrombus and infective vegetation in obstructive and nonobstructive cases.…”

“…Strands are thin, mildly echogenic, filamentous structures that are several millimeter long and move independently from the prosthesis. 35 Identification of a nonobstructive small thrombus can often be difficult and should differentiate from filamentous strands of varying length which have been seen attached to prosthetic valves. 48 They have been observed as early as 2 hours after valve replacement, suggesting that they are composed of fibrin.…”

“…Sutures are defined as linear, thick, bright, multiple, evenly spaced, usually immobile echoes seen at the periphery of the sewing ring of a prosthetic valve; they may be mobile when loose or unusually long. 35 Rarely, thrombus attached to the suture material may be detected incidentally by TTE and TEE. 49 CF is not useful in distinguishing vegetation, strand, or suture from thrombus, necessitating integration of clinical findings with echocardiography.…”

Trileaflet valve hydrodynamic resistance assessment

“…Moreover, hemolysis, regurgitation, cavitation, flow rate and effective orifice area (GEOA) are exemplar parameters to evaluate valves in vivo and in vitro. Specially, GEOA is used as clinical parameter for valvular diseases and valvular prostheses [6,[9][10][11].…”