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Detection of fibrous strands on prosthetic mitral valves with transesophageal echocardiography: another potential
L R Isada1, J N Torelli, W J Stewart
1Cleveland Clinic Foundation, OH 44195.
Abstract:
Patients with prosthetic mitral valves (MVR) have an increased incidence of cardiac embolic events, but the causes of these emboli have not been determined. Fibrous strands, detected by transesophageal echocardiography (TEE) on the left atrial side of MVRs, may be embolic precursors in these patients. However, the incidence and clinical significance of these strands are unknown. We reviewed the charts of 76 consecutive patients with MVRs who underwent a total of 83 TEE studies between January 1991 and January 1992. Of the 83 studies, 39 (47%) were of bioprostheses and 44 (53%) were of mechanical prostheses. Strands were found in 15 studies (18%) and were significantly more common in mechanical prostheses (32% vs 3%; p < 0.001). Embolic events occurred in 53% of patients with strands compared with only 18% of those without (p < 0.01). Strands were not associated with left atrial spontaneous echo contrast, left atrial thrombi, infection, prosthetic stenosis, severity of regurgitation, or left ventricular function. No physical evidence of these strands was found in the one native and three prosthetic valves examined visually during the study at the time of surgery. The data support the hypothesis that TEE evidence of strands is associated with a higher incidence of embolic events and indicate the potential for formation of intracardiac emboli on MVRs.
Insights
Fibrous strands on prosthetic mitral valves (MVRs), detected by transesophageal echocardiography (TEE), are linked to increased cardiac embolic events. These TEE-detected strands may be precursors to emboli in MVR patients.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Patients with prosthetic mitral valves (MVRs) experience a higher rate of cardiac embolic events.
- The specific causes of these emboli in MVR patients remain unclear.
- Fibrous strands on the left atrial side of MVRs, visualized via transesophageal echocardiography (TEE), are potential embolic precursors.
Purpose of the Study:
- To determine the incidence and clinical significance of fibrous strands detected by TEE in patients with MVRs.
- To investigate the association between these strands and the occurrence of embolic events.
- To explore potential embolic precursors in MVR patients.
Main Methods:
- Retrospective chart review of 76 consecutive MVR patients undergoing 83 TEE studies.
- Categorization of prostheses into bioprostheses and mechanical types.
- Analysis of TEE findings for fibrous strands and correlation with embolic events and other clinical factors.
Main Results:
- Fibrous strands were identified in 18% of TEE studies.
- Strands were significantly more prevalent in mechanical prostheses (32%) compared to bioprostheses (3%).
- Patients with strands had a higher incidence of embolic events (53%) versus those without (18%).
Conclusions:
- Transesophageal echocardiography evidence of fibrous strands on MVRs is associated with an increased incidence of embolic events.
- These strands may represent a significant risk factor for intracardiac emboli formation in MVR patients.
- Further investigation is warranted to understand the exact nature and management of these TEE-detected strands.