[The clinical and echocardiographic factors predictive of bioprosthetic leaflet rupture. The clinical tolerance for prosthetic malfunction].
OBJECTIVE
The objective of this research was to determine the existence of predictors of bioprosthetic valve disruption depending on the echocardiographic characteristic of the biologic prosthesis. It also determines the factors that provoke a need of emergency surgery and a bad clinical tolerance to the prosthetic dysfunction.


METHODS
Clinical and echocardiographic features of two groups of 28 and 21 patients, all of them carrying bioprosthesis, were compared. The groups were homogeneous in sex, age, location and durability of the prosthesis. The first group showed leaflet disruption in a period of 6 months to 1 year after the study, not in the second group. Calcification, thickness and mobility of leaflets, prosthetic function were studied. An echocardiographic score was given between 4 and 10 points. Left ventricular function and pulmonary pressure were also studied.


RESULTS
Valve thickness was statistically different in both groups (95% of the first group vs 71.3% of the second, p = 0.0281). There was no significant difference in calcification (52% vs 38.7%), nor in leaflet mobility (71.5% normal in the first group vs the 80% of the second group), nor in the prosthetic function (52.3% vs 76.6%, respectively). It was not found in the echocardiographic score either. Left ventricular function and pulmonary pressure were 91.6% and 55% normal respectively in the first group. They were 80% and 45.83% normal in the second group. Clinical onset of disruption was: 5 asymptomatic patients, 2 patients noticed a change in prosthetic click, 14 cases with progressive dyspnea, 6 patients with acute pulmonary edema and 1 patient with cardiopulmonary arrest and effective resuscitation. Symptoms were kept under control with medical treatment in 22 patients (78.55%) and 6 patients were referred to surgery. These latter suffered from pulmonary hypertension and two of them had left ventricular dysfunction. Surgical mortality was 3% (1 patient).


CONCLUSIONS
No echocardiographic features were found as being predictors of imminent bioprosthetic disruption. However, leaflet thickness is the most common finding. Symptoms of disruption in patients without high surgical risk factors (left ventricular dysfunction or pulmonary hypertension) are kept under control with medical treatment. Therefore, "prophylactic" surgery is not needed in bioprosthesis with signs of degeneration and normal hemodynamic performance.
Unidad Médico-Quirúrgica de Cardiología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid.
P
P
Gallego
A
A
González
F
F
Domíngúez
J
J
Oliver
V
V
Platero
A
A
Frutos
J
J
Jiménez
I
I
Maté
J A
JA
Sobrino
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001705:Bioprosthesis / Q000706:statistics & numerical data; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies
Factores clínicos y ecocardiográficos predictivos de rotura de velos bioprotésicos. Tolerancia clínica a la disfunción protésica.