Real-Time Three-Dimensional Transesophageal Echocardiography in the Assessment of Mechanical Prosthetic Mitral Valve Ring Thrombosis

Özkan, Mehmet; Gürsoy, Ozan Mustafa; Astarcıoğlu, Mehmet Ali; Gündüz, Sabahattin; Çakal, Beytullah; Karakoyun, Süleyman; Kalçık, Macit; Kahveci, Gökhan; Duran, Nilüfer Ekşi; Yıldız, Mustafa; Çevik, Cihan

doi:10.1016/j.amjcard.2013.05.032

Cited by 56 publications

(44 citation statements)

References 20 publications

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“…6,7 In the present case, RT3D-TEE simultaneously detected not only the stuck leaflet of the prosthetic valve, but also the thrombi in the prosthetic valve ring. This suggests that RT3D-TEE is superior to cinefluoroscopy, which is currently the standard diagnostic tool for prosthetic mitral valve obstruction.…”

Section: Discussionsupporting

confidence: 54%

“…Recently, Ozkan et al proposed an imaging strategy for differentiating obstructive thrombus from pannus, whereby thrombosis cannot be confirmed, and fibrinolysis is not advised, in cases without leaflet restriction or mass on TEE. 6 As mentioned above, RT3D-TEE can provide simultaneously detailed information about the leaflet motion and the mass. Moreover, RT3D-TEE imaging offers better understanding of the relationship between the prosthetic valve and surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

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Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Shimbo

Watanabe

Kimura

et al. 2014

J of Clinical Ultrasound

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Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Shimbo

Watanabe

Kimura

et al. 2014

J of Clinical Ultrasound

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“…[4][5][6] Two-dimensional and real-time 3-dimensional TEE accurately identify prosthetic valve thrombosis with good sensitivity. [7][8][9][10][11] However, the inability to definitively diagnose pannus is a major drawback of conventional imaging methods, though real-time 3-dimensional TEE may have some value. 12 Pannus has been reported to accompany thrombus in almost half of the cases with prosthetic valve obstruction, 13 whereas it has been reported to occur in isolation in one fifth of cases.…”

Section: See Editorial By Bonnichsen and Pellikka See Clinical Perspementioning

confidence: 99%

Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction

Gündüz

Özkan

Kalçık

et al. 2015

Circ: Cardiovascular Imaging

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101

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Background-Distinguishing pannus and thrombus in patients with prosthetic valve dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results-Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical prosthetic valve dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. Periprosthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P<0.001). Area under the receiver operating characteristic curve was 0.96 (95% confidence interval: 0.91-0.99; P<0.001), and a cutoff point of HU≥145 provided high sensitivity (87.5%) and specificity (95.5%) in discriminating pannus from thrombus. Complete lysis was more common for masses with HU<90 compared with those with HU 90 to 145 (100% versus 42.1%; P=0.007). Conclusions-Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with prosthetic valve dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates. (Circ Cardiovasc Imaging. 2015;8:e003246.

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“…1). Since these initial publications, many reports have described the use of real-time 3D TEE for imaging MV pathology [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. For example, in 2013, we published a study on the superiority of real-time 3D TEE over 2D TEE for measuring the gap and width of a MV prolapse and flail [22].…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Role of modern 3D echocardiography in valvular heart disease

Shiota

2014

Korean J Intern Med

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Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.

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Real-Time Three-Dimensional Transesophageal Echocardiography in the Assessment of Mechanical Prosthetic Mitral Valve Ring Thrombosis

Cited by 56 publications

References 20 publications

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction

Role of modern 3D echocardiography in valvular heart disease

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