title: Clinical Presentation and Value of Echocardiography in the Diagnosis of Freestyle Aortic Bioprosthesis Leaflet Tears: A Retrospective Study.
abstract: The unique design of the Freestyle stentless aortic bioprosthesis has led to different mechanisms of failure, particularly leaflet tearing. The aim of this retrospective study was to review the clinical presentation and echocardiographic data of symptomatic patients with leaflet tears and significant aortic regurgitation (AR) following implantation of the Freestyle bioprosthesis.
  
  
  
  Between January 1993 and May 2011, a total of 430 consecutive patients was identified at the authors' institution who had undergone primary aortic valve replacement with a Freestyle stentless aortic bioprosthesis. Clinical and echocardiographic data were collected prospectively for all patients. Structural valve deterioration was the major cause of bioprosthetic valve failure.
  
  
  
  Twenty symptomatic patients presented with significant AR due to leaflet tears in the absence of more than mild valvular calcification. At presentation, all patients complained of dyspnea. Some 50% of patients (n = 10) presented with acute pulmonary edema, and 10% (n = 2) with cardiogenic shock. A leaflet tear was initially diagnosed using transthoracic echocardiography in five cases (25%), using transesophageal echocardiography (TEE) in eight cases (40%), or at surgery in seven cases (35%). An appropriate diagnosis of leaflet tearing was recognized at surgery in more than one-third of patients. Consequently, clinicians must be aware of the variety of clinical presentations and should have a high degree of suspicion regarding leaflet tears in patients who have received a Freestyle stentless aortic bioprosthesis and present with moderate to severe AR.
  
  
  
  For the optimal management of patients with Freestyle stentless aortic bioprosthesis and new moderate to severe AR, TEE should be considered in all patients.
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rheault
authors.affiliation: Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.affiliation: Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.affiliation: Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.affiliation: Anatomo-Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Couture
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.affiliation: Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cinq-Mars
authors.affiliation: Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Dubois
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada. Electronic correspondence: mario.senechal@criucpq.ulaval.ca.
authors.forename: Mario
authors.initials: M
authors.lastname: Sénéchal
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001705:Bioprosthesis; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011475:Prosthesis Failure; D011654:Pulmonary Edema / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology