TRANSESOPHAGEAL DOPPLER-ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-SIDED BIOPROSTHETIC REGURGITATION - COMPARISON WITH THE TRANSTHORACIC APPROACH

The clinical value of transesophageal and transthoracic ultrasound exa minations in the assessment of bioprosthetic valve dysfunction was com pared in 21 patients(12 with mitral and 9 with aortic bioprosthetic re gurgitation). Angiography was performed in 16 patients, and pathologic al morphology of valve malfunction was confirmed by surgery or autopsy . At the mitral position, the severity of regurgitation and pathomorph ology determined by transesophageal Doppler echocardiography correspon ded well to angiographic grading and surgical or autopsy findings, res pectively. The transthoracic imaging underestimated angiographic regur gitation in 25% of patients and detected flail motion of valve leaflet s in 6 of 9 patients with torn cusps. At the aortic position, both tra nsesophageal and transthoracic approaches were of similar value in cha racterizing the possible cause of regurgitation, but the transthoracic Doppler approach provided better assessment of the degree of regurgit ation. The study indicates that transesophageal echocardiography and D oppler color flow imaging are superior to the transthoracic approach i n assessing the severity and cause of bioprosthetic mitral regurgitati on but the transthoracic approach remains useful in the evaluation of aortic bioprosthetic valve dysfunction.