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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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Cobey FC, Fritock M, Lombard FW, Glower DD, Swaminathan M. Severe tricuspid valve regurgitation: a case for laminar flow. J Cardiothorac Vasc Anesth 2012; 26:522-4. [PMID: 22387081 DOI: 10.1053/j.jvca.2012.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Frederick C Cobey
- Georgetown University, Washington Hospital Center, Washington, DC, USA
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Jayawardena S, Sooriabalan D, Burzyantseva O, Sinnapunayagm S. Paravalvular mitral valve leakage presenting as congestive heart failure, missed by TTE but diagnosed by TEE: a case report. CASES JOURNAL 2008; 1:216. [PMID: 18838002 PMCID: PMC2569914 DOI: 10.1186/1757-1626-1-216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 10/06/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnosis of prosthetic valve leakage by the transthoracic echocardiogram (TTE) technique is more difficult. These limitations are diminished with the use of transesophageal echocardiogram (TEE) techniques. CASE REPORT A 71 year old Caucasian male presented with symptoms and signs of congestive heart failure. Past medical history included a bio-prosthetic mitral valve replacement for severe mitral regurgitation. TTE showed possible mitral regurgitation. As the TTE did not correlate with the finding of a high E-velocity, a TEE was performed, which showed a significant paravalvular leak of moderate severity around the bio-prosthetic mitral valve. CONCLUSION There should be a high degree of suspicion to diagnose a paravalvular leak.
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Vitarelli A, Conde Y, Cimino E, Leone T, D'Angeli I, D'Orazio S, Stellato S. Assessment of severity of mechanical prosthetic mitral regurgitation by transoesophageal echocardiography. BRITISH HEART JOURNAL 2004; 90:539-44. [PMID: 15084553 PMCID: PMC1768237 DOI: 10.1136/hrt.2003.026823] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the ability of colour Doppler transoesophageal echocardiography (TOE) to assess quantitatively prosthetic mitral valve insufficiency. METHODS 47 patients were studied with multiplane TOE and cardiac catheterisation. Proximal jet diameter was measured as the largest diameter of the vena contracta. Regurgitant area was measured by planimetry of the largest turbulent jet during systole. Flow convergence zone was considered to be present when a localised area of increased systolic velocities was apparent on the left ventricular side of the valve prosthesis. Pulmonary vein flow velocity was measured at peak systole and diastole. RESULTS Mean (SD) proximal jet diameter was 0.63 (0.16) cm, with good correlation with angiographic grades (r = 0.83). Mean (SD) maximum colour jet area was 7.9 (2.5) cm2 (r = 0.69) with worse correlation if a single imaging plane was used for measurements (r = 0.62). The ratio of systolic to diastolic peak pulmonary flow velocity averaged 0.7 (1.3) cm (r = -0.66) with better correlation (r = -0.71) if patients with atrial fibrillation were excluded. Mean (SD) regurgitant flow rate was 168 (135) ml/s and regurgitant orifice area was 0.56 (0.43) cm2, with good correlation with angiography (r = 0.77 and r = 0.78, respectively). CONCLUSIONS TOE correctly identified angiographically severe prosthetic mitral regurgitation, mainly by the assessment of the flow convergence region and the proximal diameter of the regurgitant jet.
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Affiliation(s)
- A Vitarelli
- Department of Cardiology, La Sapienza University, Rome, Italy.
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