Transesophageal echocardiography for the diagnosis and management of nonobstructive XXXX of mechanical mitral valve prosthesis.

@entity1 @entity715 @entity955
BACKGROUND: Diagnosis of a mechanical mitral valve prosthesis @entity715 is currently made with transthoracic Doppler echocardiography and occasionally with fluoroscopy. However, identifying a @entity715 on a valve prosthesis may be difficult, especially if the @entity715 is nonobstructive. To prospectively define the role of transesophageal echocardiography for identification of nonobstructive thrombi, we studied a series of @entity1 in whom the prosthetic valve was considered to function normally on clinical examination and transthoracic echocardiography. METHODS AND RESULTS: One hundred fourteen consecutive @entity1 with mechanical mitral valve prosthesis were investigated by both transthoracic echocardiography and transesophageal echocardiography. These examinations were performed for recent systemic emboli (15 @entity1 ), fever of unknown etiology (11 @entity1 ), routine postoperative evaluation (56 @entity1 ), and other reasons (32 @entity1 ). Based on transthoracic echo diagnosis, all prostheses were considered normal. Yet, in 20 @entity1 transesophageal echocardiography revealed the presence of a 2- to 15-mm-long mobile @entity715 localized on the atrial surface of the prosthesis. When compared with the remaining 94 @entity1 with no visible thrombi, there was no significant difference between the two groups in terms of incidence of @entity955 (65% versus 52%), left atrial size (48 +/- 9 versus 51 +/- 13 mm), left ventricular end-diastolic diameter (49 +/- 10 versus 51 +/- 13 mm) and fractional shortening (28 +/- 9% versus 31 +/- 10%), presence of spontaneous contrast to the left atrium (40% versus 41%), transprosthetic mean pressure gradient (4.0 +/- 1.4 versus 3.9 +/- 1.5 mm Hg), or the type of prosthesis used. After we discovered a nonobstructive @entity715 , @entity1 were treated with heparin (n = 9) or oral anticoagulation (n = 11). The presence of a localized @entity715 was confirmed in 3 @entity1 who were operated on. In the present study, evolution appeared to depend on @entity715 size: of 14 @entity1 exhibiting a small (< 5 mm) @entity715 , 10 had an uneventful course, whereas 5 of 6 @entity1 with a large (> or = 5 mm) @entity715 developed complications or died. CONCLUSIONS: Transesophageal echocardiography appears to be a reliable method to diagnose thrombi on a mechanical mitral valve prosthesis, even when transthoracic Doppler echocardiographic parameters appear to be normal. Transesophageal echo assessment of @entity715 size may be helpful in deciding whether a @entity1 with mitral prosthesis should be treated by anticoagulation, thrombolysis, or valve rereplacement.
