[Value of echocardiography in the study of aortic valve homografts and autografts].
Although increasingly used, the echocardiographic parameters of aortic valve homografts and autografts have not been extensively investigated. The aim of this study was to assess the value of transthoracic (TTE) and transoesophageal (TOE) echocardiography in the preoperative assessment of these patients, especially with regards to prediction of homograft size and to describe the normal and pathological echocardiographic appearances of this type of prosthesis. Thirty-seven consecutive patients were studied. Before surgery, the diameter of the aortic ring (24.1 +/- 3 mm), correlated well with the value measured by the surgeon (24.4 +/- 2 mm; r = 0.9), but in 2 cases, this measurement was impossible and in 3 cases inaccurate, the difference between the 2 measurements being greater than 2 mm. It was possible to measure the aortic ring diameter in all cases by TOE. After surgery, TTE showed normal function of 33 of the 37 prosthetic valves with minimal or no obstruction (mean gradient 5.9 +/- 4 mmHg, aortic surface area = 2.8 +/- 0.5 cm2) with no significant difference between the homografts and autografts. Better visualisation of the homograft leaflets was possible by TOE and detected minimal central regurgition in 16 (84%) of the homografts examined, the persistence of an annular abscess in 2 patients and a minimal aorto-left atrial fistula in 1 patient. In conclusion. TTE coupled with Doppler examination is usually adequate for preoperative selection of the homografts and haemodynamic evaluation and follow-up of these patients. TOE should be performed preoperatively in patients with unsatisfactory TTE studies but is mainly useful for preoperative evaluation and postoperative follow-up of patients operated for aortic endocarditis with paravalvula abscess.
Habib
G
G
Service de cardiologie B, hôpital la Timone, Marseille.
Ferracci
A
A
Garcia
M
M
Ambrosi
P
P
Riberi
A
A
Kreitmann
B
B
Métras
D
D
Luccioni
R
R
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D002648:Child; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
Intérêt de l'échocardiographie dans l'étude des homogreffes et des autogreffes valvulaires aortiques.