A Case of Redo-Mitral Valve Replacement for a Björk-Shiley Delrin Valve Implanted 47 Years Previously / 日本心臓血管外科学会雑誌

We report a case of redo mitral valve replacement (MVR) for a Björk-Shiley Delrin valve implanted 47 years previously. A 71-year-old man initially underwent MVR for mitral regurgitation at our hospital at the age of 16 years. Following the operation, follow-up examinations were performed at the outpatient clinic and annual transthoracic echocardiogram findings showed only mild mitral regurgitation, with no adverse events noted. However, a transthoracic echocardiogram examination performed 45 years after the operation revealed mild to moderate mitral regurgitation, while dyspnea with exertion was also noted at that time. As part of a more detailed examination, transesophageal echocardiogram results showed moderate transvalvular leakage. Redo MVR was subsequently performed under the diagnosis of prosthetic valve dysfunction. Analysis of the explanted prosthetic valve revealed wear of the Delrin disk, and widening of the gap between the disk and strut, which were presumed to be the cause of transvalvular leakage. A half century has passed since introduction of the Björk-Shiley valve and the present is a rare case of valve malfunction. Presented here are related details, along with a review of existing literature and results of Björk-Shiley valve use at our hospital.

Transvalvular mitral regurgitation following mitral valve replacement a diagnostic dilemma.

After mitral valve replacement with a prosthetic valve, the valve should be competent and there should not be any residual prosthetic valve regurgitation. Transvalvular residual prosthetic valve regurgitation are difficult to diagnose and quantify. we are reporting interesting TEE images as a diagnostic dilemma in a case of transvalvular mitral regurgitation following mitral valve replacement secondary to entrapment of sub-valvular apparatus in a Chitra mechanical heart valve.

Correlación de los parámetros ecocardiográficos de estenosis aórtica en pacientes con fracción de eyección normal / Correlation of aortic stenosis echocardiographic parameters in patients with normal ejection fraction / Correlação dos parâmetros ecocardiográficos de estenose aórtica em pacientes com fração de ejeção normal

Introducción. El ecocardiograma es el método de elección para evaluar la severidad de la estenosis aórtica (EA), pero a menudo existen discrepancias entre los parámetros ecocardiográficos. El objetivo de nuestro trabajo fue evaluar la correlación entre los parámetros ecocardiográficos utilizados para graduar la severidad de la estenosis aórtica: área valvular aórtica (AVA), gradiente transvalvular medio (GM) y velocidad sistólica máxima (VM), y valorar la discordancia entre el AVA y el GM para el diagnóstico de EA severa. Material y métodos. Se incluyeron de forma consecutiva pacientes a los que se les realizó un ecocardiograma transtorácico como parte del seguimiento de su estenosis aórtica. Se calculó el AVA por ecuación de continuidad, el AVA indexado (AVAi), la VM y el GM con Doppler continuo. Mediante el método de correlación bivariada se obtuvo el coeficiente de correlación de Pearson entre las variables AVA y AVAi-GM, AVA y AVAi-VM. Se consideró una p<0,05, estadísticamente significativa. Además, se dividió a la población en 4 grupos de acuerdo a los siguientes parámetros ecocardiográficos, AVA ≥1 cm² y <1cm²; AVAi ≥0,6 cm²/m² y <0,6 cm²/m² y GM ≥40 mm Hg y <40 mm Hg. Las variables categóricas se expresan en porcentaje y las variables continuas en promedio y desviación estándar. Resultados. Fueron incluidos 104 pacientes con un AVA promedio de 1,24 ± 0,40 cm², AVAi promedio de 0,67 ± 0,22 cm²/m², una VM promedio de 3,34 ± 0,89 m/seg y un GM promedio de 27,9 ± 17,6 mm Hg. Hubo correlación significativa entre las variables: AVA-GM (coeficiente de correlación 0,738; p<0,01), AVA-VM (coeficiente de correlación de 0,801; p<0,01). Se mantuvo la misma correlación cuando se comparó GM y VM con AVAi. Al dividir por grupos de acuerdo al área valvular y GM, hubo discordancia de los parámetros ecocardiográficos de estenosis aórtica severa en 12,5% y 17,3%, con AVA o AVAi, respectivamente. Conclusión. Existe correlación estadística entre los parámetros ecocardiográficos para evaluar la EA, pero hay discordancia de 12,5 ó 17,3% entre el AVA o AVAi, respectivamente, y GM para valorar EA severa.

Backround. Echocardiography is the method of choice for evaluating the severity of aortic stenosis, but there are often discrepancies between echocardiographic parameters. The aim of our study was to evaluate the correlation between echocardiographic parameters used to grade the severity of aortic stenosis: aortic valve area (AVA), mean transvalvular gradient (MG) and peak systolic velocity (PV) and assess the discordance between AVA and mean gradient for the diagnosis of severe aortic stenosis. Material and methods. We included consecutively patients who underwent transthoracic echocardiography as part of follow up of aortic stenosis. Was calculated AVA by continuity equation, indexed AVA (iAVA), PV and MG with continuous Doppler. By the method of bivariate correlation was obtained Pearson correlation coefficient between AVA and iAVA-MG, AVA and iAVA-PV. We considered a p<0.05 statistically significant. In addition, the population was divided into 4 groups according to the following echocardiographic parameters, AVA ≥1 cm² and <1 cm²; iAVA ≥0.6 cm²/m² and <0.6 cm²/m² and GM ≥40 mm Hg and <40 mm Hg. Results. We included104 patients with a mean AVA of 1.24 ± 0.40 cm², a mean iAVA of 0.67 ± 0.22 cm²/m², a mean PV of 3.34 ± 0.89 m/sec and a mean MG of 27.9 ± 17.6 mm Hg. There was significant correlation between the variables: AVA-MG (correlation coefficient 0.738, p<0.01), AVA-PV (correlation coefficient of 0.801, p<0.01). Remained the same correlation when compared iAVA with MG and PV. Dividing into groups according to valve area and MG, there was discrepancy of echocardiographic parameters of severe aortic stenosis in 12.5% and 17.3%, with AVA or iAVA respectively. Conclusion. Statistical correlation exists between echocardiographic parameters to assess aortic stenosis, but there is disagreement of 12.5 or 17.3%, between AVA or iAVA and mean gradient respectively to assess severe aortic stenosis.

Introdução. O ecocardiograma é o método de escolha para avaliar a gravidade da estenose aórtica, mas muitas vezes há divergências entre os parâmetros ecocardiográficos. O objetivo do nosso estudo foi avaliar a correlação entre os parâmetros ecocardiográficos utilizados para classificar a gravidade da estenose aórtica: área da válvula aórtica (AVA), gradiente transvalvular médio (GM) e velocidade sistólica máxima (VM), e avaliar a discordância entre AVA e GM para o diagnóstico de estenose aórtica grave. Material e métodos. Foram incluídos consecutivamente pacientes que se submeteram a ecocardiografia transtorácica como parte do monitoramento de sua estenose aórtica. A AVA foi calculada pela equação da continuidade, a AVA indexada (AVAi), a VM e GM com Doppler continuo. Pelo método de correlação bivariada foi obtido coeficiente de correlação de Pearson entre as variáveis AVA e AVAi-GM, AVA e AVAi-VM. Foi considerado uma p<0,05 estatisticamente significativa. Além disso, a população foi dividida em quatro grupos de acordo com os seguintes parâmetros ecocardiográficos, AVA ≥ 1 cm2 e <1 cm²; AVAi ≥0,6 cm²/m² e <0,6 cm²/m² e GM ≥40 mm Hg e < 40 mm Hg. As variáveis categóricas foram expressas em porcentagens e as variáveis contínuas em média e desvio padrão. Resultados. Foram incluídos 104 pacientes com uma AVA média de 1,24 ± 0,40 cm², AVAi média de 0,67 ± 0,22 cm²/m², uma VM média de 3,34 ± 0,89 m/seg e um GM média de 27,9 ± 17,6 mm Hg. Houve correlação significativa entre as variáveis: AVA-GM (coeficiente de correlação 0,738, p<0,01), AVA-VM (coeficiente de correlação de 0,801, p<0,01). Mesma correlação foi mantida quando comparado GM e VM com AVAi. Dividindo-se em grupos de acordo com a área da válvula e GM, houve discordância de parâmetros ecocardiográficos de estenose aórtica grave em 12,5% e 17,3%, com AVA ou AVAi, respectivamente. Conclusão. Existe correlação estatística entre os parâmetros ecocardiográficos para avaliar ...

Application research of transvalvular pressure gradient by real-time color Doppler echocardiography in percutaneous balloon pulmonary valvuloplasty / 中华超声影像学杂志

ObjectiveTo assess the value of transvalvular pressure gradient (TPG) by use of realtime color Doppler echocardiography in percutaneous balloon pulmonary valvuloplasty (PBPV).Methods Patients with pulmonic stenosis (80 cases) were performed by PBPV,in which the pilmonic annular diameter and TPG were measured by using of 2-D and color Doppler echocardiography in the different periods of this operation.Results The pilmonic annular diameter was not significantly difference by intraoperative echocardiography and radiography measurement (t =2.013,P ＞ 0.05).And pressure measurement by catheterization pre- and post-dilatation was not markedly significant ( t =1.258,P ＞0.05).However,TPG in patients with the different degree of pulmonic stenosis were decreased significantly ( P ＜0.01).PBPV treatments in the mild pulmonic stenosis for twice got an excellent effect according to operation criteria,but PBPV treatment in patients with the moderate and severe pulmonic stenosis need to be done for three times.ConclusionsReal-time color Doppler echocardiography is an effective way and plays a guiding role in PBPV.