Trastornos de conducción auriculoventricular tras implantación de prótesis aórtica CoreValve ®. Papel predictivo de la ecocardiografía transesofágica / Atrioventricular conduction disturbances after CoreValve ® aortic prosthesis implantation. Predictive role of transesophageal echocardiography

Tras el implante de prótesis percutánea aórtica CoreValve®, pueden aparecer trastornos de conducción auriculoventricular que precisan marcapasos permanente (un 40-45% de los pacientes). El objetivo de nuestro estudio es detectar si alguna variable ecocardiográfica de 2 o 3 dimensiones podría predecir la aparición de trastornos de conducción auriculoventricular. Para ello se estudió en 26 pacientes consecutivos la relación de la prótesis con el septo interventricular; 12 pacientes (46,1%) presentaron trastornos de conducción auriculoventricular tras el procedimiento. Una penetración protésica en el tracto de salida del ventrículo izquierdo > 12 mm y una superficie de contacto del stent de la prótesis con el septo interventricular en diástole > 90% se asociaron fuertemente con la aparición de trastornos de conducción auriculoventricular (87,5%; p=0,034). La superficie de contacto del stent resultó ser el único predictor independiente de dicha complicación (odds ratio=1,12; intervalo de confianza del 95%, 1,01-1,25; p=0,03). Los resultados indican que la implantación más alta de las prótesis y la reducción de la longitud del stent podrían reducir la frecuencia de esta complicación (AU)

Atrioventricular conduction disorders can appear after the implantation of percutaneous aortic CoreValve® prostheses in patients requiring permanent pacemakers (40%-45% of these patients). The aim of our study was to detect if 2- or 3-dimensional echocardiographic variables could predict the appearance of atrioventricular conduction disorders. For this purpose, the relationship of the prosthesis with the interventricular septum was studied in 26 consecutive patients. Twelve patients (46.1%) developed atrioventricular conduction disorders. A prosthetic penetration >12 mm in the left ventricular outflow tract and a contact surface >90% between the interventricular septum and the stent of the prosthesis in diastole were strongly associated with the appearance of conduction disturbances (87.5%; P=.034). The percentage of the prosthetic stent in contact with the interventricular septum in end diastole was the only independent predictor of atrioventricular conduction disorders (odds ratio=1.12; 95% confidence interval, 1.01-1.25; P=.03). The results suggest that a higher implantation of the prosthesis and a reduced stent length might decrease the incidence of this complication (AU)

[Atrioventricular conduction disturbances after CoreValve(®) aortic prosthesis implantation. Predictive role of transesophageal echocardiography]. / Trastornos de conducción auriculoventricular tras implantación de prótesis aórtica CoreValve(®). Papel predictivo de la ecocardiografía transesofágica.

Atrioventricular conduction disorders can appear after the implantation of percutaneous aortic CoreValve(®) prostheses in patients requiring permanent pacemakers (40%-45% of these patients). The aim of our study was to detect if 2- or 3-dimensional echocardiographic variables could predict the appearance of atrioventricular conduction disorders. For this purpose, the relationship of the prosthesis with the interventricular septum was studied in 26 consecutive patients. Twelve patients (46.1%) developed atrioventricular conduction disorders. A prosthetic penetration >12 mm in the left ventricular outflow tract and a contact surface >90% between the interventricular septum and the stent of the prosthesis in diastole were strongly associated with the appearance of conduction disturbances (87.5%; P=.034). The percentage of the prosthetic stent in contact with the interventricular septum in end diastole was the only independent predictor of atrioventricular conduction disorders (odds ratio=1.12; 95% confidence interval, 1.01-1.25; P=.03). The results suggest that a higher implantation of the prosthesis and a reduced stent length might decrease the incidence of this complication.

Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?

BACKGROUND: Segmental analysis in mitral prolapse is important to decide the chances of valvular repair. Multiplane transesophageal echocardiography (TEE) is the only echocardiographic tool validated for this aim hitherto. The aim of the study was to assess if segmental analysis can be performed with transthoracic real-time 3-dimensional (3D) echocardiography as accurately as with TEE, hence representing a valid alternative to TEE. METHODS: Forty-one consecutive patients diagnosed with mitral prolapse underwent TEE and a complete 3D echocardiography study, including parasternal and apical real-time; apical full-volume; and 3D color full-volume. Investigators performing TEE were blinded to the 3D results. RESULTS: Three-dimensional echocardiogram was feasible in 40 to 41 patients (97.7%). Ages ranged from 15 to 92 years, and all possible anatomical patterns of prolapse were represented. Thirty-seven patients (90.2%) had mitral regurgitation of any degree. The level of agreement was k = 0.93 (P < or = .0001), sensitivity of 96.7%, specificity of 96.7%, likelihood ratio for a positive result of 29.0%, and likelihood ratio for a negative result of 0.03%. Four false positives were found, corresponding to scallops A2 (1), A3 (2), and P3 (1). Four false negatives were found, corresponding to scallops A1 (2) and P1 (2). Sensitivity and specificity in the scallop P2 were 100%. CONCLUSION: Segmental analysis in mitral prolapse can be performed with transthoracic real-time 3D echocardiography as accurately as with TEE. False negatives tend to appear around the anterolateral commissure, whereas false positives tend to appear around the posteromedial commissure. Highest accuracy was reached in central scallops.