Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings

Girard, Steven; Miller, Fletcher A.; Orszulak, Thomas A.; Mullany, Charles J.; Montgomery, Thomas; Edwards, William D.; Tazelaar, Henry D.; Malouf, Joseph F.; Tajik, A. Jamil

doi:10.1016/s0735-1097(00)01113-x

Cited by 56 publications

(37 citation statements)

References 24 publications

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“…2-8, 10 Girard et al reported that the incidence of previous DVR was 31% in 49 patients with reoperation for mechanical AV obstruction. 3 In that series, the cause of mechanical AV obstruction was pannus in 25 (53%), mismatch in 19 (39%), and thrombus in 4 (8%) patients. The incidence of rheumatic heart disease was only 45%.…”

Section: Discussionmentioning

confidence: 80%

“…In Girard's series in which the incidence of rheumatic disease was 45%, mitral valve surgery was required in 12 (24%) and tricuspid valve surgery in 9 (18%) patients. 3 Oh et al reported an incidence of concomitant tricuspid valve surgery of 67% and of mitral valve surgery of 27% in a series of 33 cases with reoperation for subaortic pannus. 7 In our study, 16 MVRs (32%: 14 repeat, 2 primary) and 36 tricuspid valve surgeries (72%: 15 TVRs, 21 tricuspid valve repairs) were performed.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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Background: This study aimed to evaluate the early and late clinical outcomes after repeat aortic valve replacement (AVR) for subaortic pannus in patients with mechanical valves. Methods and Results:Between 2001 and 2017, 51 patients (median age, 59 years; 42 women) with prosthetic aortic stenosis (AS) caused by pannus ingrowth underwent repeat AVR because of acute malfunction of monoleaflet valve (3 patients), severe prosthetic AS (30 patients), and moderate prosthetic AS at the time of tricuspid or mitral valve surgery (18 patients). The median follow-up duration was 100 (interquartile range, 64-138) months. Double valve replacement was performed in 45 (88%) patients. Median time interval from previous operation was 161 (interquartile range, 121-194) months. The explanted mechanical AV was monoleaflet and bileaflet in 16 (31%) and 34 (67%) patients, respectively. Concomitant procedures included 16 mitral valve replacements (14 repeat) and 36 tricuspid valve surgeries (15 replacements, 21 repairs). No hospital deaths or cases of heart block occurred. Overall survival and event-free survival rates at 10 years were 88% and 51%, respectively. Late complications included recurrent prosthetic AS (4 patients), new paravalvular leakage of the mitral valve (5 patients), and severe tricuspid regurgitation (2 patients). Conclusions:Although repeat AVR for subaortic pannus had acceptable early and late survival, recurrent prosthetic AS was frequently observed during late follow-up.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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“…Thromboses can be treated with thrombolysis, whereas pannus formation requires surgical intervention. Although TTE and TEE are useful modalities for evaluating the severity of valve obstruction, they are less suitable for aortic valve obstruction because of acoustic shadowing, particularly if the mass is located on the anterior side of the aortic prosthetic valve [30,31].…”

Section: Thrombosis and Pannus Formationmentioning

confidence: 99%

Postoperative Complications after Surgical Aortic Valve Replacement

Koo

Lee

Anh

et al. 2017

Cardiovasc Imaging Asia

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Aortic valve replacement is one of the most common major cardiac surgeries worldwide. Despite improvements in surgical techniques, postoperative complications after aortic valve surgery remain a source of substantial morbidity and mortality. Although transthoracic echocardiography and transesophageal echocardiography have been used for routine surveillance of prosthetic heart valves, computed tomography (CT) has played an important role with echocardiography in the diagnosis, treatment, and follow-up of patients after valve replacement. CT has the advantage of evaluating the extent of disease, such as paravalvular dehiscence, abscess, and pseudoaneurysm, in aortic prosthetic valves. In this article, we review the various image findings of postoperative complications after aortic valve replacement detected on CT.

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“…Thrombus was not seen in the ventricular aspect of On-X valve. We measured the size of thrombus with direct planimetry in diastole phase on axial views using the method of multi-planner reconstruction [8]. The area of thrombus was calculated to be 0.4 cm 2 in total.…”

Section: Casementioning

confidence: 99%

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography

et al. 2015

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A 62-year-old female patient underwent mitral valve replacement with a 31/33-mm On-X valve for ischemic mitral valve regurgitation. Three months later, transthoracic echocardiography incidentally showed a blocked leaflet with 6 mmHg of mean pressure gradient and 2.4 cm(2) of mitral valve orifice area. Transesophageal echocardiography could not detect thrombus. Electrocardiographically gated multidetector-row computed tomography (MDCT) clearly demonstrated a blocked leaflet in the close position and thrombus (2 cm in length, 0.4 cm(2) in area) attached onto the atrial aspect of the leaflet. These findings observed by MDCT were confirmed at reoperation. MDCT was useful diagnostic method for visualizing prosthetic valve thrombosis.

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Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings

Abstract: Doppler TTE is the primary means to diagnose AVR obstruction; hemodynamic catheterization is not routinely needed. In unselected patients with mechanical AVR obstruction, TEE differentiation of pannus or thrombus from mismatch is challenging.

Cited by 56 publications

References 24 publications

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Postoperative Complications after Surgical Aortic Valve Replacement

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography

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