Intraoperative echocardiographic detection of regurgitant jets after valvereplacement

Background. Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, ye t the significance of these jets is unknown. Methods. Twenty-seven patients had intraoperative transesophageal two-dimen sional color Doppler echocardiography, performed to assess the number and a rea of regurgitant jets after valve replacement, before and after protamine . Patients were grouped by first time versus redo operation, valve position and type. Results. Before protamine, 55 jets were identified (2.04 +/- 1.4 per patien t) versus 29 jets after (1.07 +/- 1.2 per patient, p = 0.0002). Total jet a rea improved from 2.0 +/- 2.2 cm(2) to 0.86 +/- 1.7 cm(2) with protamine (P < 0.0001). In all patients jet area decreased (average decrease, 70.7% +/- 27.0%). First time and redo operations had similar improvements in jet num ber and area (both p > 0.6). Furthemore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tiss ue valves, respectively. Conclusions. Following valve replacement, multiple jets are detected by int raoperative transesophageal echocardiography. They are more common and larg er in the mitral position and with mechanical valves. Improvement occurs wi th reversal of anticoagulation. (C) 2000 by The Society of Thoracic Surgeon s.