VALUE AND LIMITATIONS OF MONOPLANE TRANSE SOPHAGEAL ECHOCARDIOGRAPHY IN THE STUDY OF PROSTHETIC AORTIC-VALVE DYSFUNCTION

The authors reviewed retrospectively the results of transoesophageal a nd transthroracic echocardiography in 26 patients with prosthetic aort ic valve dysfunction in order to study the value and limitations of mo noplane transoesophageal echocardiography in this condition. Surgical data was available in 14 of these cases. The diagnosis of abscess of t he aortic ring was made on 7 occasions by transoesophageal echocardiog raphy and on 3 occasions by transthoracic echocardiography Bacterial v egetations were visualised in 5 cases by transoesophageal echocardiogr aphy and in 1 case by transthoracic echocardiography. The diagnosis of thrombosis was made in 1 case by transoesophageal echocardiography an d missed by transthoracic echocardiography ; fibrous pannus (n = 1) wa s not recognised on transoesophageal and transthoracic echocardiograph y. In the latter two conditions, transthoracic Doppler showed signs of obstruction. The diagnosis of a stenotic bioprosthesis due to fibroca lcific degeneration was made in 1 case by transoesophageal and in 1 ca se by transthoracic echocardiography. Prolapse of cusp was diagnosed i n 6 cases by transthoracic echocardiography. An intraprosthetic valve leak was visualised in 7 cases by transoesophageal echocardiography an d in 9 cases by transthoracic echocardiography ; periprosthetic leaks were diagnosed in 9 cases by transoesophageal and in 12 cases by trans thoracic echocardiography. These results indicate that transoesophagea l echocardiography is a major advance in the diagnosis of abscess of t he aortic ring, bacterial vegetations and prosthetic valve thrombosis. On the other hand, transthoracic echocardiography remains superior fo r the quantification or regurgitation and enables evaluation of transp rosthetic gradients of obstructive prostheses with continuous mode Dop pler. Therefore, the two methods are complementary.