Two-dimensional echocardiographic detection of left ventricular wall impaction by mitral prosthesis

Real-time two-dimensional echocardiographic (2DE) studies detected impaction of the Starr-Edwards mitral valve prosthesis with the left ventricular wall in eight patients (septum in seven, posterior wall in one). One patient with echocardiographic evidence of posterior wall impaction died; autopsy revealed grooving of the left ventricular posterior wall by the cage. Four of seven patients with ventricular septal impaction developed ventricular arrhythmias in the in-hospital postoperative period which were persistent and difficult to control in two patients, but were not fatal. None of the 22 patients without ventricular wall impaction had ventricular arrhythmias. 2DE appears to be a useful noninvasive technique in detecting left ventricular wall impaction by mitral prosthesis, a potentially lethal complication.