[Value of early systematic postoperative transesophageal echocardiography in mitral valve replacements. A prospective study of 50 patients].
The aim of this study was to assess the value of routine transoesophageal echocardiography in the early postoperative period after mitral valve replacement. The authors report their experience in 50 consecutive operated patients (43 mechanical and 7 bioprostheses) investigated routinely by this method in the postoperative period in the surgical unit. Abnormal findings were observed in 36% of cases (18 patients): trans-prosthetic leaks (8 cases) and thrombosis (10 cases) in 2 bioprostheses and 8 mechanical prostheses; in 3 cases this led to haemodynamic dysfunction but in 7 cases the thrombus had no influence on the trans-prosthetic pressure gradient. No predisposing factor could be identified (spontaneous contrast, left atrial volume, left ventricular function, poor anticoagulation, blood clotting abnormalities). No abnormality of the mobile components of the prosthesis was observed at radioscopy. The outcome with heparin therapy was favourable with disappearance of the thrombi in 6 cases; the thrombi did not regress in 4 patients on heparin: 2 patients underwent thrombolytic therapy with a complete cure in 1 case and a severe embolic complication in the other; in 2 cases, the thrombus was so big that the patients were reoperated. Systematic early postoperative transoesophageal echocardiography before discharge from the surgical unit would seem to be necessary after early mitral valve replacement: it allows diagnosis of asymptomatic thrombosis which has an important emboligenic potential. The management of these thromboses remains controversial, but the poor natural outcome in cases of large thromboses should lead to referral for early reoperation.
Malergue
M C
MC
Centre médico-chirurgical de la Porte de Choisy, Paris.
Temkine
J
J
Slama
M
M
Dibie
A
A
Ledavay
M
M
Benrabbha
T
T
Laborde
F
F
Lecompte
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D004947:Esophagus; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011475:Prosthesis Failure; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology
Intérêts de l'échocardiographie transoesophagienne systématique postopératoire précoce des remplacements valvulaires mitraux. Une étude prospective sur 50 patients.