title: Comparison of transthoracic and transesophageal echocardiography in evaluation of 47 Starr-Edwards prosthetic valves.
abstract: OBJECTIVE
  Our objectives were to characterize by transesophageal echocardiography the normal appearance of the Starr-Edwards prosthetic heart valve and to compare the utility of transesophageal and transthoracic echocardiography in detection of valve abnormality.
  
  
  BACKGROUND
  The Starr-Edwards prosthetic heart valve, the first mechanical valve to be used, has demonstrated excellent durability.
  
  
  METHODS
  Fifty transthoracic and transesophageal echocardiographic studies on 37 patients with 47 Starr-Edwards prosthetic valves were analyzed retrospectively. Six cases of surgically confirmed infective endocarditis were studied.
  
  
  RESULTS
  Vegetation or abscess formation, or both, was identified by transesophageal echocardiography in all six cases of infective endocarditis but was found in only one of these cases by transthoracic echocardiography. Thrombus was detected by transesophageal echocardiography in 9 of 11 patients with transient ischemic attacks or stroke and in 2 patients by transthoracic echocardiography with 3 confirmed at surgery. In 26 of the 30 patients with a mitral Starr-Edwards valve, the valve demonstrated a trivial or mild "closing volume" early systolic or holosystolic leak on transesophageal echocardiography alone. Transthoracic evaluation identified significant mitral regurgitation in six of the eight patients who had this finding on transesophageal echocardiography. Serial studies were performed to assess response to treatment or need for surgical intervention in eight patients. Seventeen valves have been implanted for 12 years; six of these had significant leakage without apparent cause, a finding not observed more recently implanted valves.
  
  
  CONCLUSIONS
  These observations demonstrated the unique utility of transesophageal echocardiography in patients with Starr-Edwards prosthetic valve dysfunction, endocarditis or thrombus formation, and of the clear superiority of transesophageal echocardiography over transthoracic echocardiography in these situations.
authors.affiliation: Ohio State University Hospitals, Division of Cardiology, Columbus.
authors.forename: M E
authors.initials: ME
authors.lastname: Alton
authors.forename: T J
authors.initials: TJ
authors.lastname: Pasierski
authors.forename: D A
authors.initials: DA
authors.lastname: Orsinelli
authors.forename: G M
authors.initials: GM
authors.lastname: Eaton
authors.forename: A C
authors.initials: AC
authors.lastname: Pearson
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000592:standards; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D004947:Esophagus / Q000000981:diagnostic imaging*; D005069:Evaluation Studies as Topic; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D013909:Thorax / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors