Comparison of transthoracic and transesophageal color Doppler flow imaging in patients with mechanical prostheses in the mitral valve position

• Published in: The American journal of cardiology Vol. 63; no. 20; pp. 1471 - 1474
• Main Authors: van den Brink, Renée B.A., Visser, Cees A., Basart, Dick C.G., Düren, Donald R., de Jong, Anton P., Dunning, Arend J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.06.1989; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Echocardiography, Doppler - methods; Female; Heart Valve Prosthesis; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - pathology; Mitral Valve Insufficiency - diagnosis; Prosthesis Failure; Regional Blood Flow; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Heart; Doppler ultrasound study; Human; Atrium; Mitral valve; Prosthesis; Ultrasonic investigation; Cardiovascular disease; Systole; Heart valve; Blood flow; Esophagus; Cardiac valvular disease; Color echography; Surgery; Regurgitation; Hemodynamics; Chest wall; Ultrasonic transducer
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(89)90010-6

This study determined the relative value of transthoracic and transesophageal color Doppler flow imaging to systolic flow patterns in the left atrium in different types of mechanical prostheses in the mitral valve. Thirty-nine patients were investigated. Based on clinical findings, 36 of 39 patients had normal prosthetic valve function. Seventeen patients were interrogated within a few days after surgery. Systolic regurgitant jets in the left atrium were absent in all patients by both transthorack pulsed and color Doppler flow imaging. Using transthorack continuous wave Doppler, however, jets were demonstrated in 8 of 39 patients (21%). Transesophageal color Doppler flow imaging demonstrated systoic regurgitant jets originating from the prosthesis in all patients. Tilting disc valves showed jets during the entire systole (closure and leakage backflow). Each type of prosthesis generated a specific jet pattern. Pathologic regurgitant jets were crescent-shaped, more extensive and turbulent than jets caused by normal closure and leakage backflow. Thus, transthorack color Doppler flow imaging is not sensitive for detecting regurgitant jets in mechanical prostheses in the mitral valve. All mechanical prostheses show a specific jet pattern, which should be helpful when transesophageal echocardiography is used to identify pathologic backflow.