Subject(s)
Aortic Valve Insufficiency/diagnosis , Bioprosthesis , Echocardiography , Heart Valve Prosthesis , Mitral Valve Insufficiency/diagnosis , Adult , Aged , Aortic Valve Insufficiency/etiology , Equipment Failure , Humans , Male , Mitral Valve Insufficiency/etiology , Phonocardiography , SystoleABSTRACT
Phonocardiographic findings are reported in 19 patients with normally functioning Ionescu-Shiley prostheses in the mitral or aortic position. Opening clicks were recorded in all 8 patients with mitral prostheses at a mean second heart sound (A2) to opening click interval of 94 ms. In 9 subjects, apical systolic murmurs were found. All 11 patients with the prosthesis in the aortic position had systolic ejection murmurs. Opening clicks were observed in 8 patients with a mean Q wave to opening click interval of 125 ms; closing clicks were found in 9 of 11. No diastolic murmurs occurred in this group. These acoustic characteristics serve as a reference source for the noninvasive evaluation of the bovine pericardial prosthesis.
Subject(s)
Bioprosthesis , Heart Auscultation , Heart Valve Prosthesis , Phonocardiography , Adult , Aortic Valve , Female , Heart Murmurs , Heart Sounds , Humans , Male , Middle Aged , Mitral Valve , PericardiumABSTRACT
Using M-mode and 2-dimensional (2-D) echocardiography, ultrasonic features of the Ionescu-Shiley valve were characterized. A number 23 prosthesis was placed in a saline-filled chamber and subjected to pulsatile flow. Production of a linear tear at the base of a cusp resulted in coarse fluttering in the open position, and there was a reduction in the anterior cusp slope. Partial detachment of a cusp from its stent produced high-amplitude low-frequency fluttering during ejection. Alteration of transducer position eliminated the abnormal echoes. Fourteen patients with aortic and 11 with mitral prostheses were studied. There was a close approximation of echographically determined values for the bare stent internal diameter, cusp excursion, and valve orifice diameter compared with the manufacturer's specifications. Random punctiform echoes were noted when the cusps opened. Cusp echoes were superimposed on stent echoes in 21% of patients, and a third cusp was detected in 29%. Two-dimensional echocardiograms of good quality were recorded in the vast majority of subjects. Cusp echoes were smooth and had a consistent motion in both the short and longitudinal axis. Multiple transducer positions were required to delineate prosthetic components with optimal clarity. It is concluded that (1) M-mode and 2-D echocardiography is useful in assessing Ionescu-Shiley valve function, (2) in vitro valve tears or detachment produces characteristic cusp fluttering, (3) careful attention to transducer positions is necessary to record high-quality valve images, and (4) these findings represent a data base for the longitudinal follow-up study of patients with the Ionescu-Shiley valve.
Subject(s)
Bioprosthesis , Echocardiography/methods , Heart Valve Prosthesis , Adult , Aged , Aortic Valve , Humans , Middle Aged , Mitral Valve , PericardiumABSTRACT
Two-dimensional echocardiography permitted identification of a large free-floating left atrial thrombus in a patient with mitral stenosis. A specific pattern of motion afforded its recognition and differentiation from mural left atrial thrombosis and tumors. Phonocardiographic tracings revealed a non-ejection systolic click and opening snap. A gated blood pool scintigram disclosed a left atrial filling defect. Subsequent left atrial angiography and left atriotomy confirmed the non-invasive findings.
