Clinical Utility of Transesophageal Echocardiography(TEE) in Prosthetic Valve Dysfunction

ABSTRACT

BACKGROUND: Better imaging resolution and less flow masking with TEE than with TTE makes it easier to evaluate the prosthetic valve dysfunction. However, direct comparison between two methods to evaluate prosthetic valve dysfunction remains elucidated. METHODS: Both TTE and TEE were performed in 19 patients with suspected prosthetic valve dysfunction who were admitted to Seoul National University Hospital for evaluating porsthetic valve dysfunction from July, 1992 to May, 1993 and those findings were compared with those of cardiac catheterization and angiography, and surgery 19 cases were included in this study. RESULTS: 11 patients with congestive heart failure underwent TTE, TEE and angiography and each finding was compared to one another. We could see that there is good correlation between transesophageal echocardiographic and angiographic grading in the severity of regurgitation but poor correlation between transthoracic echocardiographic and angiographic finding in that of regurgitation. We also could differentiate between central and eccentric leakage with TEE and in 2 cases TEE enabled us to detect a vegetation on prosthetic valve not detected with TTE and in 1 case the cause of cardiac hemolysis could be known with TEE eccentric leakage in prosthetic mitral valve. Left atrial thrombi were detected with TEE in two patients with recent cerebral infaction history. CONCLUSION: We conclude that TEE is a good method that enables us to diagnosize the prosthetic valve dysfunction and detect the structural abnormalities surrounding prosthetic valve such as paravalvular leakage, vegetation, cardiac hemolysis and Left atrial thrombi not detected easily by TTE.