Romero CA, Victoria CJL, Franco ZMG, Roldán GFJ, Vargas BJ

Language: Spanish
References: 9
Page: 141-147
PDF size: 107.35 Kb.

ABSTRACT

Echocardiographic findings in six patients with obstructive intermittent dysfunction of mechanical disc prosthetic mitral valve (OIPD) are described. All with a clinical picture of gradual installation and progressive dyspnea of several weeks of evolution. TTE with Bd recordings were performed in all of them with “oriented” M mode from apical 4/C view. The findings were compared with a control group of 14 patients with normal prosthetic valves. In the group of OIDP, all patients displayed a variable delay in the opening of the prosthetic disc, registered as a “protodiastolic step” in M mode. In three patients, the dysfunction was due to a thrombus. In two, due to pannus. Three were operated. One with thrombolysis. In two, the treatment consisted of heparin and increased oral anticoagulation. None die during the acute handling of the intermittent dysfunction. Two patients died: one seven months later due to cardiac failure and the other a year later due to prosthetic rethrombosis. In patients with mechanical prosthetic valve in mitral valve position and progressive dyspnea, the presence of a variable delay in the opening of the prosthesis is diagnostic of OIDP and requires urgent handling with thrombolysis or surgery.

REFERENCES

1. Wellford AL, Wellford LA: Prosthetic Heart Valve. Emergency Med Clinics of N Am 1994; 12: 597-631.

2. García del Castillo H, Evangelista Masip A: Disfunción Protésica. Rev Esp Cardiol 1990; 43: 569-80.

3. Vongpatanasin W, Hillis LD, Lange RA: Prosthetic Heart Valves. N Engl J Med 1996; 335: 407-16.

4. Labovitz AJ: Assessment of Prosthetic Heart Valve Function by Doppler Echocardiography. A Decade of Experience. Circulation 1989; 80: 707-709.

5. Cunha CL, Giuliani ER, Callahan JA, Pluth JR: Echocardiographic Findings in Patients with Prosthetic Heart Valve Malfunction. Mayo Clin Proc 1980; 55: 231-242.

6. Khandheria BK, Seward JB, Oh JK, Freeman WK, Nichols BA, Sinak LJ, Miller FA Jr, Tajik AJ: Value and Limitations of Transesophageal Echocardiograpy in Assessment of Mitral Valve Prostheses. Circulation 1991; 83: 1959-68.

7. Delgado C, Bonnin O, Garriga JM, Barril R, Barturen F: Intermitent Electromechanical Dissociation as an Unusual Sign of Prosthetic Valve Thrombosis in Patient with Prosthetic Fibrous Ingrowth. J Am Soc Echocardiogr 2000; 13: 685-9.

8. Garg NK, Kapoor A, Sinha N: Intermitent electromechanical dissociation due to mechanical prosthetic valve dysfunction. J Heart Valve Dis 2000; 9: 466-8.

9. Fernandes V, Olmos L, Nagueh SF, Quinones MA, Zoghbi WA: Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function. Am J Cardiol 2002; 89: 704-10.