RESUMO
Echocardiography was performed in 10 consecutive patients who had a clinically normally functioning porcine aortic bioprosthesis in the mitral position. Strong well defined echoes were recorded from the anterior and posterior aspects of the xenograft stent. The maximal separation of the anterior and posterior stent echoes approximated the diameter of the stent at its base. The maximal excursion of the anterior stent was 5 to 10 mm (mean 7.5) with a mean systolic slope of 15 to 35 mm/sec (mean 22.2) and diastolic slope of 11 to 59 mm/sec (mean 21.5). In all 10 patients it was possible to record an anterior xenograft leaflet with anterior movement at the onset of diastole and posterior movement at the onset of systole and with appropriately steep (more than 200 mm/sec) slopes. The diastolic (E-F) slope of the anterior leaflet in 9 of the 10 patients ranged from 9 to 38 mm/sec (mean 19). In 6 of the 10 patients a posterior xenograft leaflet with a movement pattern symmetric with that of the anterior leaflet was recorded. In two patients, the central aortic leaflet was recorded with little diastolic displacement. These two patients also had mild aortic regurgitation, which was associated with diastolic shudder of the xenograft leaflets. Echocardiography was also performed in one patient who was later shown to have a 10 cm3 thrombus on the ventricular surface of a xenograft valve. The echocardiogram in this patient revealed the following abnormalities: (1) excessive anterior stent movement and systolic slope suggesting paravalvular leak in the presence of abnormal cinefluoroscopic valve tilt, and (2) multiple dense nonhomogeneous echoes between the anterior and posterior aspects of the valve stent, with an early diastolic clear space behind the anterior stent and abnormal echoes behind the posterior stent during systole. Echocardiography therefore appears to be useful in evaluating the porcine aortic bioprosthesis in the mitral position.
Assuntos
Valva Aórtica/transplante , Valva Mitral/cirurgia , Transplante Heterólogo , Adulto , Idoso , Animais , Ecocardiografia , Septos Cardíacos/fisiopatologia , Ruídos Cardíacos , Humanos , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Desenho de Prótese , Suínos , Trombose/fisiopatologiaRESUMO
Echocardiographic studies were used to diagnose a thrombus adherent to the ventricular surface of a stent-mounted porcine aortic heterograft valve in the mitral position. Multiple, intense, irregularly thickened echoes were present within and behind the anterior and posterior heterograft valvular stent. This suggested the presence of adherent biologic material, such as a thrombus. The abnormal echocardiographic findings are compared to the findings in a normally functioning porcine heterograft aortic valve in the mitral position.
Assuntos
Valva Aórtica/transplante , Ecocardiografia , Artéria Femoral/cirurgia , Próteses Valvulares Cardíacas/métodos , Artéria Ilíaca/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico , Trombose/diagnóstico , Transplante Heterólogo , Adulto , Animais , Humanos , Masculino , SuínosRESUMO
The report of a failure of glutaraldehyde-preserved porcine aortic xenograft bioprosthesis in the aortic position after 13 months is presented. Severe aortic regurgitation resulted from three "idiopathic" perforations in one of the cusps, and a linear tear in another cusp. Light and electron microscopy showed generalized degeneration of collagen thoughout the faulty valve. The absence of a platelet-fibrin coat on edges of the tear suggested a recent origin, compatible with cardiac catheter manipulation during unsuccessful attempts to cross the valve. The histopathologic data from this valve correlate with previously reported failures with formaldehyde preserved xenograft valves.