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Echo-phonocardiographic evaluation of the Björk-Shiley mitral prosthesis
Insights
Combined echophonocardiography effectively detects Björk-Shiley mitral valve issues. Specific timing intervals are key for identifying prosthetic malfunction and left ventricular failure after valve replacement.
Area of Science:
- Cardiology
- Biomedical Engineering
- Prosthetic Heart Valves
Background:
- Björk-Shiley prosthetic mitral valves are used for valve replacement.
- Monitoring these valves post-surgery is crucial for patient outcomes.
- Combined echophonocardiography offers a method for evaluating valve function and cardiac health.
Purpose of the Study:
- To evaluate the efficacy of combined echophonocardiography in detecting complications after Björk-Shiley mitral valve replacement.
- To identify specific echocardiographic and phonocardiographic measures indicative of prosthetic malfunction and left ventricular (LV) failure.
- To determine the most useful parameters for differentiating normal function, malfunction, and LV failure.
Main Methods:
- Ninety patients with Björk-Shiley mitral valves underwent combined echophonocardiography.
- Patients were followed up every 6 months for a mean of 6 years.
- Various prosthetic motion parameters and timing intervals were analyzed, including valve opening/closing velocity, amplitude, septal motion, LV dimensions, and specific time intervals between cardiac sounds and valve movements.
Main Results:
- Nine cases of left ventricular (LV) failure and 6 cases of prosthetic malfunction (5 paravalvular leaks, 1 thrombosis) were detected.
- All evaluated measures were useful for detecting prosthetic malfunction.
- Two specific intervals proved most useful: the interval between the second heart sound and mitral valve opening, and the interval between the aortic valve closure sound and LV posterior wall motion.
Conclusions:
- Combined echophonocardiography is effective in monitoring Björk-Shiley mitral valve prostheses.
- Specific timing intervals derived from echophonocardiography can reliably detect prosthetic malfunction and LV failure.
- The identified key intervals allow for discrimination between normal valve function, prosthetic malfunction, and LV failure, aiding clinical management.
Abstract:
Ninety patients were studied with combined echophonocardiography after Björk-Shiley disc prosthetic mitral valve replacement. They were evaluated every 6 months (mean follow-up 6 years). Nine cases of left ventricular (LV) failure and 6 cases of prosthetic malfunction (5 paravalvular leaks and 1 thrombosis) were detected; 1 case was confirmed at necropsy and the other 5 cases were surgically verified and repaired. The following measures of prosthetic malfunction were evaluated: opening and closing velocity, maximal amplitude of the prosthesis, septal motion 6 months after operation, LV diastolic diameter, protodiastolic hump, variations during same record of the interval between aortic valve closure sound to the phono and mitral valve opening to the echo, and interval between aortic valve closure sound and maximal excursion of the LV posterior wall. All measures studied were useful for detecting prosthetic malfunction, but 2 are more useful in individual cases: variations of the interval between second heart sound and mitral valve opening and the interval between the aortic valve closure sound and LV posterior wall motion. These 2 intervals also allow discrimination between normal function, prosthetic malfunction and LV failure.