Revista argentina de cardiología
versión On-line ISSN 1850-3748
CIANCIULLI, Tomás F et al. Cinefluoroscopic Assessment of Eight Models of Bivalve Mechanical Heart Valve Prosthesis Implanted in the Argentine Republic: Its Value as a Complementary Method to Color-Doppler Echocardiography. Rev. argent. cardiol. [online]. 2008, vol.76, n.1, pp. 27-34. ISSN 1850-3748.
Many types of mechanical prosthesis are used for heart valve replacement, but it is difficult to distinguish between them using transthoracic echocardiography. Cinefluoroscopy (CF) may complement the echocardiographic evaluation of cardiac prosthesis. Objectives 1) To describe the contribution of cinefluoroscopy in identifying different prosthesis. 2) To assess heart valve prosthesis function comparing gradients obtained by Doppler echocardiography with the opening angle of the tilting discs got by CF. 3) To recognize the ability of CF in the assessment of normal versus dysfunctional cardiac prosthesis. Material and Methods Two hundred and nineteen heart valve prosthesis implanted in 191 patients were prospectively assessed. Fourteen prosthesis were excluded owing to severe systolic left ventricular dysfunction. All calculations were performed on 205 heart valve prosthesis (142 aortic valves and 63 mitral valves). Results Cinefluoroscopy was able to identify 100% of cardiac valve prosthesis models according to ring and discs features. Disc motion assessment could differentiate between normal and dysfunctional prosthesis (opening angle 79.3°±5.4° versus 58.7°±15°, respectively). Cinefluoroscopy could not define disc profile or ring profile in 3.9% of aortic prosthesis and in 19.2% of mitral prosthesis. Among 142 aortic prosthesis, echo-Doppler identified 112 normal and 30 dysfunctional prosthesis, while among 63 mitral prosthesis, 52 normal and 11 dysfunctional cardiac prosthesis were recognized. When both methods were correlated, sensitivity, specificity and positive and negative predictive values of fluoroscopy to distinguish between normal and malfunctioning prosthesis were 83%, 80%, 89%, and 71%, respectively. Conclusions 1) Each model of heart valve prosthesis has its own cinefluoroscopic features which allow its identification. 2) Cinefluoroscopy assesses mechanical prosthesis function, and distinguishes between a normal and a dysfunctional prosthesis. 3) In cases of high gradients and absence of thrombus and pannus by transesophageal echocardiography (TEE), the presence of normal opening angles at CF identifies patient-prosthesis mismatch. 4) Fluoroscopy is superior to echo-Doppler to assess disc motion, while echo-Doppler allows the measurement of gradients and areas, and the semi quantification of regurgitation. Thus, both methods should be considered complementary.
Palabras clave : Heart Valve Diseases; Heart Valve Prosthesis; Echocardiography; Fluoroscopy.