title: Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: the Massachusetts General Hospital experience, 1989-2000.
abstract: Accurate assessment of suspected prosthetic valve dysfunction is critically important as reoperation carries high risk. Noninvasive methods of hemodynamic assessment of patients with both aortic and mitral mechanical valves continue to be frustrated by the interference created by prosthetic material and direct left ventricular puncture may be required for definitive hemodynamic assessment. We report the hemodynamic and angiographic results and outcomes of 38 consecutive patients with double valve replacement who underwent left ventricular puncture as part of evaluation of possible prosthetic dysfunction. These results were compared with those obtained by noninvasive testing. We found noninvasive assessment alone to be unsatisfactory as measurements of regurgitation and stenosis correlated poorly with those obtained by direct left ventricular puncture. Important information that altered patient management was obtained from invasive assessment in 68% of cases with an acceptable rate of complications. Therefore, hemodynamic and angiographic assessment using transthoracic left ventricular puncture should be entertained in patients with mitral and aortic valve replacement presenting with congestive heart failure and suspected prosthesis dysfunction.
authors.affiliation: Cardiology Division, Medical Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sanchez
authors.forename: Maximo
authors.initials: M
authors.lastname: Rodriguez-Alemparte
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Colon-Hernandez
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hourigan
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008404:Massachusetts; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011475:Prosthesis Failure; D011677:Punctures; D012189:Retrospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*