Doppler echocardiographic appearance of cusp tears in tissue valve prosthesis

Characteristic Doppler echocardiographic abnormalities were noted in five patients with a failing tissue prosthesis shown to have severe regurgitation and no evidence of obstruction. The audio signal was musical in quality and the regurgitant flow pattern was bidirectional and striated. There were 4 to 6 striations in the mitral and 18 in the aortic regurgitant jets per 100 cm/s length of signal. Pulsed Doppler ultrasound localized the jet to the valve in all cases although angiography failed to localize it in one of four cases. At surgery each valve had a tear in or partial disintegration of one cusp whereas the other two cusps were intact, mobile and of normal thickness. The Doppler appearance is thought to be caused by fluttering of the disrupted cusp leading to the shedding of families of vortices in both a retrograde and an orthograde direction. It is suggested that this is likely to be a useful sign for the diagnosis of cusp tears.