[Regurgitation jets in mitral prosthesis studied using transesophageal echocardiography].
OBJECTIVE
To analyze the regurgitant jets of mitral valve prostheses studied by transesophageal echocardiography.


METHODS
Prospective study of patients with mitral prostheses with or without suspicion of dysfunction.


METHODS
Patients referred to the Echocardiology Department of the Instituto de Cardiologia in Madrid, some as outpatients.


METHODS
Twenty five patients with mitral valve prostheses (5 biological, 7 St Jude, 12 Bjork Shiley and 1 Hall Kaster). Ten male patients and fifteen female, mean age 50 years. Five also had aortic valve prostheses. In only 5 there was a suspicion of dysfunction. The transthoracic echos were done with phased array transducers and the transthoracic with 2.5 (18 patients) or 5 MHz (7 patients) transducers coupled to a commercial echocardiographer. The presence of regurgitant jets was looked for, as well as their origin, maximal area and length, their type and degree of turbulence.


RESULTS
Only 3 mitral regurgitations were noticed by transthoracic echocardiography. All the mechanical prostheses and 80% of the biological ones had regurgitant jets by transesophageal echocardiography. The tilting disc prostheses had two physiological jets, the St. Jude 2, 3, or exceptionally only one central jet. The biological prostheses had one central regurgitant jet, that was smaller than those from the mechanical prostheses (p less than 0.05). There were ten malfunctioning prostheses (5 Bjork Shiley, 3 St Jude and 2 biological). The diagnosis of dysfunction was based on the abnormal origin of the jet (9 cases) or just simply on the characteristics of the regurgitation (turbulence). Four patients were submitted to surgery, all with dysfunctioning prostheses.


CONCLUSIONS
Transthoracic echocardiography has a low sensitivity for detecting the regurgitant jets of mitral prostheses. All mechanical prostheses and 80% of biological ones have regurgitation by transesophageal echocardiography. The area and length of the jets are not so different between normal and malfunctioning prostheses in order to separate them. The abnormal jets are recognised because of their abnormal origin and/or their characteristics, with formation of mosaic in color coded Doppler echocardiography.
Branco
L M
LM
Interna do Internato Complementar com o grau de Assistente Hospitalar de Cardiologia, Hospital de Santa Marta, Lisboa.
Garcia-Fernandez
M A
MA
Moreno
M
M
Azevedo
J E
JE
D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D011475:Prosthesis Failure
Estudos dos fluxos de regurgitação de próteses mitrais obtidos por ecocardiografia transesofágica.