New valvular substitutes: Role of echocardiography

In view of the imperfection of conventional valvular prostheses, new valvul ar substitutes are being increasingly used, especially in the aortic positi on. They include homografts, stentless bioprostheses and autografts (Ross' procedure). They all involve a more complex surgical technique requiring sp ecific training, identical implantation techniques and similar short and me dium-term complications. Echocardiography plays a major role in the assessment of these prostheses, perhaps even greater than with conventional valve prostheses. Before surger y, the nature and severity of the valvular and perivalvular lesions are dem onstrated, the size of the aortic annulus measured and the appearances of t he ascending aorta described. This information is used to optimise the surg ical tactics. Transoesophageal echo cardiography is essential during surger y and is an integral part of the surgical procedure with these new valvular substitutes allowing peroperative diagnosis of incomplete surgical results which may require immediate correction. After surgery, transoesophageal echocardiography is the investigation of ch oice for long-term follow-up and is recommended for regular surveillance of these patients, as after all valve replacement procedures.