Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography

Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algo rithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997, Clinical and echocardiographic parameters were analyzed to identify p redictors of thrombus and pannus, Prevalence of thrombus and diagnostic yie lds relative to the number of predictors were determined. There were 22 pat ients with thrombus, 19 patients with pannus, and 12 patients with both. Fo rty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 i solated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0,009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of less than or equal to2.5 (p = 0,03), All 34 patients with thrombus or mixed presentation had less th an or equal to1 predictor. The prevalence of thrombus in the presence of le ss than or equal to1, 2, and greater than or equal to3 predictors is 14%, 6 9%, and 91%, respectively, Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD, An algorithm based on clinical and tr ansesophageal echocardiographic predictors may be useful to estimate the li kelihood of thrombus in the setting of MPVD, In the presence of greater tha n or equal to3 predictors, the probability of thrombus is high. (C) 2000 by Excerpta Medica, Inc.