OBSTRUCTION OF THE ST-JUDE MEDICAL VALVE - DIAGNOSTIC AND THERAPEUTICVALUES OF CINERADIOGRAPHY

Between 1984, and 1992, we observed 8 patients with an obstructed St. Jude Medical (SJM) valve. Of these, 1 had an obstructed SJM valve in t he aortic position, 3 in the mitral position, and 4 in the tricuspid p osition. Diagnosis of obstruction of the SJM valve was made by cinerad iography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed b y cineradiography in all of the 8 patients. Normal range of leaflet mo bility of the SJM valve was measured by conventional cineradiography i n 70 patients with a normal SJM valve, and the results were compared w ith the leaflet mobility obtained from the 8 patients with an obstruct ed SJM valve. In this study, leaflet function in the obstructed SJM va lve was strikingly abnormal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 underwent urgent prosthetic valve replacements after cineradiography and echocardiography were carried out. Thrombolysis using urokinase wa s performed in 4 patients, and this treatment was successful in 1 pati ent. Efficacy of thrombolytic therapy was evaluated by repeat cineradi ography. Three of the 4 patients who received thrombolysis showed no s ignificant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with e chocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function. Although thrombolytic therapy is considere d the first choice of treatment for obstructed SJM valve in selected p atients, patients who do not respond to thrombolytic therapy within 48 -72 hours should be referred for surgery.