NORMAL ECHOCARDIOGRAPHIC CHARACTERISTICS OF THE SORIN-BICARBON BILEAFLET PROSTHETIC HEART-VALVE IN THE MITRAL AND AORTIC POSITIONS

Doppler echocardiographic characteristics of normally functioning Sori n Bicarbon prostheses were prospectively assessed in 226 consecutive p atients (135 male and 91 female patients; mean age 61 +/- 10 years) wi th 233 valves in the mitral(n = 67) and aortic (n = 166) positions who se function was considered normal by clinical and echocardiographic ev aluation. Patterns of ''normal'' transprosthetic leakage were assessed with transthoracic echocardiography in all valves and with transesoph ageal echocardiography in six selected mitral valve prostheses. For th e mitral valve prostheses, we found that peak and mean gradient, as we ll as pressure half-time, were not significantly different in either t he 25 or the 31 nun valves (median values from 15 to 10 mn Hg, from 4 to 4 mm Hg, and from 70 to 83 ms; p = Not significant for all). On tra nsthoracic study, 12 patients (17%) with a Sorin Bicarbon valve in the mitral position showed minimal transprosthetic leakage. On transesoph ageal study, all patients showed a transprosthetic leakage whose spati al distribution had a complex pattern: in planes orthogonal to the lea flet axis, two to four jets arising from the hinge points and convergi ng toward the center of the valve plane could be visualized; in planes parallel to the leaflet axis, there were three jets, the two lateral ones diverging and the central one perpendicular to the valve plane. F or the aortic valve prostheses, there was a significant decrease in tr ansprosthetic gradients and an increase in effective orifice areas as prosthesis size increased. Peak and mean gradients decreased from a me dian value of 25 and 13 mm Hg in the 19 mm valves to 9 and 5 mm Hg in the 29 mm valves, respectively. Effective prosthetic valve area calcul ated with the continuity equation increased from a median value of 0.9 7 cm(2) for the 19 mm size valves to 3.45 cm(2) for the 29 mm size. Wi th analysis of variance, effective prosthetic aortic valve area differ entiated various valve sizes (F = 40.9, p < 0.0001) better than peak ( F = 10.3, p < 0.0001) or mean (F = 8.04, p < 0.0001) gradients alone d id. Furthermore, effective prosthetic aortic valve area correlated bet ter than peak and mean gradients with prosthetic size (r = 0.76, r = - 0.45, and r = -0.39, respectively). On transthoracic study, 109 patien ts (66%) showed minimal transprosthetic leakage. These normal values, obtained in a large number of patients with normofunctioning mitral an d aortic Sorin Bicarbon valves, may help to identify Sorin Bicarbon pr osthesis dysfunction.