Intracardiac echocardiography imaging of periprosthetic valvular regurgitation.
A 62-year-old woman was referred for evaluation of recent-onset dyspnoea at rest and a newly found systolic heart murmur, heard best at the apex of the heart. The patient's history was notable for surgical mitral valve replacement 3 years ago, due to severe mitral regurgitation (myxomatous degeneration of the mitral valve). The transthoracic echocardiogram gave the impression of a mitral regurgitant jet, but the acoustic shadow of the prosthesis did not allow adequate evaluation of the regurgitation. A transoesophageal echocardiogram was performed showing a normally functioning mitral prosthesis, with a small periprosthetic leak (Figure 1, upper panel), disproportionate to the patient's symptoms and marked signs of haemolysis. An intracardiac ultrasound study revealed a large paravalvular regurgitant jet, indicating significant periprosthetic regurgitation (Figure 1, lower panel). Intracardiac echocardiography is increasingly being used to guide percutaneous interventions and electrophysiological procedures. The present case suggests a potentially useful widening of the range of intracardiac ultrasound clinical applications, out of the realm of device-closure interventions and electrophysiological procedures. It appears that intracardiac echocardiography could become a second-line alternative to transoesophageal echocardiography, especially in patients with contraindication to the latter.
Deftereos
Spyridon
S
Cardiology Department, Athens General Hospital 'G. Gennimatas', 154 Mesogeion ave., 11527, Athens, Greece.
Giannopoulos
Georgios
G
Raisakis
Konstantinos
K
Kaoukis
Andreas
A
Kossyvakis
Charalambos
C
D002304:Cardiac Pacing, Artificial; D017548:Echocardiography, Transesophageal; D005260:Female; D006321:Heart; D006337:Heart Murmurs / Q000000981:diagnostic imaging / Q000473:pathology; D006350:Heart Valve Prosthesis; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology