Transesophageal echocardiography (TEE) is especially suitable for examination of prosthetic valves because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs. This article reviews normal and abnormal morphologic characteristics of prosthetic valves such as spontaneous echocontrast, microbubbles, strands, sutures, vegetations or thrombus. Doppler echocardiographic characteristics of normal and pathologic prosthetic valve function and the management of prosthetic valve pathology is discussed. Physicians taking care of patients with prosthetic valves should be familiar with the characteristics of normal and abnormally functioning prosthetic valves.
Get full access to this article
View all access options for this article.
References
1.
Ionescu AA, Moreno de la Santa P, et al: Mobile echoes on prosthetic valves are not reproducible. Results and clinical implications of a multicenter study. Eur Heart J20:140-147,1999.
2.
Shu MCS, Leuer LH, Armitage TL, et al: In vitro observation of mechanical heart valve cavitation. J Heart Valve Dis3(Suppl 1):85-93,1994.
3.
Kort A, Kronzon I: Microbubble formation: In vitro and in vivo observation. J Clin Ultrasound10:117-120,1982.
4.
Kingsbury C, Kafesjian R, Guo G, et al: Cavitation threshold with respect to dP/dt: Evaluation in 29 mm bileaflet; pyrolytic carbon heart valves. Int J Artif Organs16:515-520,1993.
5.
Kaymaz C, Özkan M, Özdemir Nihal, et al: Spontaneous echocardiographic microbubbles associated with prosthetic mitral valves: Mechanistic insights from thrombolytic treatment results. J Am Soc Echocardiogr15:323-327,2002.
6.
Girod G, Jaussi A, Rosset C, et al: Cavitation versus degassing: In vitro study of the microbubble phenomenon observed during echocardiography in patients with mechanical prosthetic cardiac valves. Echocardiography19(7 Pt 1):531-536,2002.
7.
Rozich JD, Edwards WD, Hanna RD, et al: Mechanical prosthetic valve-associated strands: Pathologic correlates to transesophageal echocardiography. J Am Soc Echocardiogr16:97-100,2003.
8.
Hutchinson K, Hafeez F, Woods TD, et al: Recurrent ischemic strokes in a patient with Medtronic-Hall prosthetic aortic valve and valve strands. J Am Soc Echocardiogr11:755-757,1998.
9.
Ionescu AA, Newman GR, Butchart EG, et al: Morphologic analysis of a strand recovered from a prosthetic mitral valve: No evidence of fibrin. J Am Soc Echocardiogr12:766-768,1999.
10.
Orsinelli DA, Pearson AC: Detection of prosthetic valve strands by transesophageal echocardiography: Clinical significance in patients with suspected cardiac source of embolism. J Am Coll Cardiol26:1713-1718,1995.
11.
Wang Z, Grainger N, Chambers J: Doppler echocardiography in normally functioning replacement heart valves: A literature review. J Heart Valve Dis4:591-614,1995.
12.
Van den Brink RBA, Visser CA, Basart DCG, et al: Comparison of transthoracic and trans esophageal color Doppler flow imaging in patients with mechanical prostheses in mitral valve position. Am J Cardiol63:1471-1474,1989.
13.
Foster GP, Isselbacher EM, Rose GA, et al: Accurate localization of mitral regurgitant defects using multiplane transesophageal echocardiography. Ann Thorac Surg65:1025-1031,1998.
14.
Pibarot PH, Dumesnil JG, Cartier PC, et al: Patient-prosthesis mismatch can be predicted at the time of operation. Ann Thorac Surg71:S265-S268,2001.
15.
Blais C, Dumesnil JG, Baillot R, et al: Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation108:983-988,2003.
16.
Lin SS, Tiong IYH, Asher CR, et al: Prediction of thrombusrelated mechanical prosthetic valve dysfunction using transesophageal echocardiography Am J Card86:1097-1101,2000.
17.
Barbetseas J, Nagueh SF, Pitsavos C, et al: Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: An evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol32:1410-1417,1998.
18.
Montorsi P, De Bernardi F, Muratori M, et al: Role of cinefluoroscopy, transthoracic, and transesophageal echocardiography in patients with suspected prosthetic heart valve thrombosis. Am J Cardiol85:58-64,2000.
19.
Hurrell DG, Schaff HV, Tajik AJ: Thrombolytic therapy for obstruction of mechanical prosthetic valves. Mayo Clinics Proc71:605-613,1996.
