DETECTION OF PROSTHETIC VALVE STRANDS BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY - CLINICAL-SIGNIFICANCE IN PATIENTS WITH SUSPECTED CARDIAC SOURCEOF EMBOLISM

Objectives. The purpose of this study was to determine how frequently prosthetic valve strands are associated with prosthetic mitral and aor tic valves, as detected by transesophageal echocardiography, and to as sess their significance in relation to clinical cardioembolic events. Background. Strands attached to prosthetic mitral valves are a recentl y described finding of uncertain clinical significance. There are no r eports of strands attached to aortic valve prostheses, and data are li mited concerning the relation of valvular strands to cardioembolic eve nts. Methods. We identified all transesophageal echocardiographic stud ies performed during a 5-year period at our institution for evaluation of valve dysfunction or a suspected cardioembolic event in patients w ith a valve prosthesis. All studies were reviewed. The presence of str ands was noted and the prevalence compared between patients evaluated for a suspected cardioembolic event and those evaluated for valve dysf unction. In patients with no strands detected, the presence of other p otential cardiac sources of embolism was noted. Results. Strands were detected in 56 (26%) of 214 studies. There was a significant differenc e (p = 0.0001) in the prevalence of strands between studies performed for a suspected cardioembolic event (34 [53%] of 64) versus those perf ormed for suspected valve dysfunction (22 [15%] of 150). Strands were more prevalent on mitral than on aortic valves (32% vs. 13%, p = 0.000 1) and were more frequently detected on mechanical than on bioprosthet ic valves (27% vs. 8%, p = 0.003). Among patients with a suspected car dioembolic event and normal valves, other potential cardiac sources of embolism were detected in 67%. Conclusions. Prosthetic valve strands are frequently detected by transesophageal echocardiography. They are more commonly detected in patients being evaluated for a suspected car dioembolic event and thus represent a potential cardiac source of embo lism, In patients with apparently normal valves, other potential sourc es of embolism are frequently detected. Thus, transesophageal echo car diography may have a significant impact on the management of these pat ients.