title: Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography.
abstract: OBJECTIVE
  The goal of this study was to determine the outcome of trivial or mild periprosthetic regurgitation (PPR) identified by intraoperative transesophageal echocardiography (TEE).
  
  
  BACKGROUND
  The clinical significance, natural history and correlates of trivial or mild PPR detected early after surgery are unknown.
  
  
  METHODS
  Between 1992 and 1997, 608 consecutive patients underwent isolated aortic valve replacement or mitral valve replacement at Dartmouth-Hitchcock Medical Center. Of these, 113 patients (18.3%) were found to have trivial or mild PPR at surgery by TEE. Follow-up transthoracic echocardiograms (early TTEs) were obtained within six weeks of surgery in 99.0% of patients and late TTEs (mean 2.1 years) in 54.3%. Clinical, intraoperative and outcome variables associated with PPR were identified using t test, chi-square and logistic regression analyses.
  
  
  RESULTS
  By univariate analysis, compared with patients without PPR, patients with PPR were older, of smaller body surface area (BSA), had degenerative valve disease more often and were more likely to receive a bioprosthetic valve. By multivariate analysis, smaller BSA and the use of a bioprosthesis were the strongest predictors of PPR (p < 0.01). At early TTE, PPR was not observed (n = 56) or remained unchanged (n = 44) in all patients. At late TTE, four patients were found to have progression of their PPR. All four patients had bioprosthetic valves. Two of these patients had endocarditis, and one had primary valvular degeneration. The fourth patient had progressive PPR.
  
  
  CONCLUSIONS
  Trivial or mild PPR is a frequent finding on intraoperative TEE. Smaller body size and the use of a bioprosthetic valve are significantly associated with PPR. The clinical significance and natural history of PPR is benign in most cases.
authors.affiliation: Section of Cardiology, Veterans Affairs Hospital, White River Junction, Vermont, USA. Daniel.O'Rourke@Hitchcock.org
authors.forename: D J
authors.initials: DJ
authors.lastname: O'Rourke
authors.forename: R T
authors.initials: RT
authors.lastname: Palac
authors.forename: D J
authors.initials: DJ
authors.lastname: Malenka
authors.forename: C A
authors.initials: CA
authors.lastname: Marrin
authors.forename: B E
authors.initials: BE
authors.lastname: Arbuckle
authors.forename: J F
authors.initials: JF
authors.lastname: Plehn
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors