title: Intraoperative echocardiographic detection of regurgitant jets after valve replacement.
abstract: BACKGROUND
  Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown.
  
  
  METHODS
  Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type.
  
  
  RESULTS
  Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively.
  
  
  CONCLUSIONS
  Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.
authors.affiliation: Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Morehead
authors.forename: M S
authors.initials: MS
authors.lastname: Firstenberg
authors.forename: T
authors.initials: T
authors.lastname: Shiota
authors.forename: J
authors.initials: J
authors.lastname: Qin
authors.forename: G
authors.initials: G
authors.lastname: Armstrong
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D011479:Protamines / Q000627:therapeutic use; D012086:Reoperation; D018084:Ultrasonography, Interventional
chemical_list: D006494:Heparin Antagonists; D011479:Protamines