[Early transesophageal echocardiography after mitral valve replacement. Significance of minor abnormal signals].
The aim of this study was to determine the frequency, significance and prognosis of small, abnormal, strand-like echos observed by early transoesophageal echocardiography after mitral mechanical valve replacement with hemi-disc prostheses. One hundred and twenty nine consecutive patients operated between October 1988 and June 1992 underwent transoesophageal echocardiography on average 15 +/- 7 days after surgery. A second transoesophageal echocardiography was performed in 52 patients on average 8 months after the first postoperative examination. The frequency of small strand-like echos and of non-obstructive thromboses of the valve at the initial transoesophageal examination was 43% and 8.5% respectively. A multivariate analysis showed that the only independent predictive factor for prosthetic valve strands was spontaneous intra-atrial contrast (p < 0.01). The presence of strands was significantly related to the prevalence of early thrombo-embolic events (confirmed non-obstructive valve thrombosis and systemic embolism). Strands were observed in 80% of cases with early thromboembolic complications compared with only 38% of cases with no early thromboembolic events (p < 0.04). Univariate analysis showed that the protamine/heparin ratio at the end of cardiopulmonary bypass and the percentage of ineffective postoperative heparinisation were higher in patients with these small, abnormal echos (p < 0.05 and p < 0.001, respectively). These appearances disappear at long-term transoesophageal echocardiographic control examinations in about half the cases. The authors conclude that the majority of these small, abnormal echos are thrombotic in nature and are associated with a higher thromboembolic risk, justifying effective anticoagulation in the first postoperative hours whenever possible, considering the risk of bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
Dadez
E
E
Service de cardiologie, hôpital Tenon, Paris.
Iung
B
B
Cormier
B
B
Hoffman
O
O
Drissi
M F
MF
Tsezana
R
R
Vahanian
A
A
Acar
J
J
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D011475:Prosthesis Failure; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000517:prevention & control
D000925:Anticoagulants
Echocardiographie transoesophagienne précoce après remplacement valvulaire mitral. Signification des petits échos anormaux.