Cloth tears in asymptomatic survivors of aortic valve replacement with Starr-Edwards prostheses: detection by transesophageal echocardiography.
Cloth-covered Starr-Edwards valves were withdrawn in the 1970s because of complications of cloth tear. Nevertheless, many patients are still alive with their prosthesis in place. We evaluated the ability of transesophageal echocardiography (TEE) to detect cloth tear in 9 asymptomatic patients operated on with a cloth-covered Starr-Edwards aortic valve at our institution. An echogenic mobile structure attached to the prosthesis, suggestive of a tear, was detected in 5 patients (55%). A tear was diagnosed in a sixth patient when TEE was repeated during follow-up because of neurologic symptoms. In all cases, transthoracic echocardiography failed to detect any abnormality. Two patients had symptoms develop and underwent reoperation; cloth tear was more extensive than suspected by TEE. Cloth tear is a frequent finding that can be detected by TEE in asymptomatic patients with cloth-covered Starr-Edwards aortic prosthesis. TEE is recommended in these patients and reoperation should be considered as soon as symptoms appear.
Vermes
Emmanuelle
E
Department of Medicine and Surgery, Montreal Heart Institute, Canada.
Tardif
Jean-Claude
JC
Cartier
Raymond
R
Mercier
Lise-Andrée
LA
Ducharme
Anique
A
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation