Feasibility of two-dimensional bileaflet valve imaging: a prospective transthoracic echocardiographic study

The study aim was to explore the feasibility of demonstrating prosthetic bileaflet valve leaflet motion by two-dimensional (2D) transthoracic echocardiography (TTE).

A total of 103 consecutive patients (55 females, 48 males; mean age 60.0+/-13.7 years), with a total of 119 normally functioning left-sided bileaflet valves (61 mitral, 58 aortic), was studied prospectively by TTE in six views each. A distinct, symmetric movement of both leaflets in opposite directions was considered a positive finding.

Bileaflet motion imaging was feasible for all mitral prostheses. The mean number of positive views per valve was 3.6+/-0.9, and this was unaffected by valve model. The number of positive views was less for small (25 mm) valves than larger valves (2.7+/-1.1 versus 3.7+/-0.9; p = 0.007). The best views were four- and three-chamber (82% and 75.4% positive, respectively). Bileaflet imaging was feasible in 77.6% of patients with aortic prostheses (50% in two or more views). The mean number of positive views was 1.6+/-1.2, and this was unaffected by valve model and size. The parasternal short- axis and subcostal views provided the majority of positive imaging (84.4%).

2D imaging on TTE can reliably demonstrate normal mitral bileaflet motion. However, this procedure is less accurate for aortic valves, and other diagnostic modalities (transesophageal echocardiography or fluoroscopy) should be implemented when malfunction is suspected.