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COMPLEMENTARY VALUE OF TRANSTHORACIC ECHOCARDIOGRAPHY AND CINEFLUOROSCOPIC EVALUATION OF MECHANICAL HEART PROSTHETIC VALVES
Author(s) -
Cianciulli T.F.,
Lax J.A.,
Cerruti F.E.,
Gigena G.E.,
Redruello H.J.,
Orsi M.A.,
Gagliardi J.A.,
Dorelle A.N.,
Riccitelli M.A.,
Prezioso. H.A.
Publication year - 2004
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.0742-2822.2004.t01-22-20040211.x
Subject(s) - medicine , sinus rhythm , fluoroscopy , cardiology , prosthesis , mitral valve , aortic valve , body orifice , mitral regurgitation , cardiac skeleton , regurgitation (circulation) , atrial fibrillation , surgery , anatomy , aortic valve replacement , stenosis
Many different mechanical heart valve prostheses (MVP) are used but in most of the cases transthoracic echocardiography (TTE) cannot recognize the type and the information obtained from the patients about the implanted prostheses is incomplete or lacking. Objective: (1) To compare TTE transprosthetic gradients with cinefluoroscopic (F) prosthetic disc opening angles, and (2) To determine F utility in MVP dysfunction diagnosis. Methods: 100 MVP implanted in 84 patients (47 men and 37 female; mean age 59 ± 17 y/o, 63 in sinus rhythm) were prospectively evaluated with F; 68 had aortic and 32 mitral. Results: TTE was not useful in identifing the type of prosthesis, but F was successful in all cases. F could not obtain the “in profile projection” (with the radiographic beam parallel to both the valve ring plane and the tilting axis of leaflets) in 15% aortic and 30% mitral valve prostheses. F identified Tri‐Technologies and HP‐Biplus prostheses, but no functional data were obtained due to disc radiopacity absence. In aortic valve prostheses, the opening angle was 53 ± 17°, the maximal and mean pressure gradients were 27 ± 14 mmHg, and the correlation gradient‐opening angles was r =−0.73 (95% CI, −0.85 to −0.53) p < 0.0001. In mitral valve prostheses the opening angle was 56 ± 24°, the effective orifice area was 1.43 ± 0.52 cm 2 and the correlations effective orifice area‐opening angles was: r =−0.74 (95% CI 0.21 to 0.93) p < 0.001). Conclusions: (1) Fluoroscopy is a low‐cost, quick, and simple noninvasive procedure that permits distinguishing between normal and dysfunctioning MVP. (2) With adequate orientation of the X‐ray film, fluorosocpy measured the complete opening of the prosthetic valve, indicating free motion of the tilting disc and allowed distinguishing between normal and dysfunctioning MVP. (3) When TTE detected high gradients with fluoroscopic normal motion of the disc, prosthetic–patient mismatch is diagnosed. (4) Fluorosocpy is superior to TTE for identifing the motion of the disc; nonetheless, both techniques should be considered complementary and not exclusive.