Detection of prosthetic valve strands by transesophageal echocardiography: clinical significance in patients with suspected cardiac source of embolism

Department of Medicine, Ohio State University, Columbus 43210, USA.

OBJECTIVES. The purpose of this study was to determine how frequently prosthetic valve strands are associated with prosthetic mitral and aortic valves, as detected by transesophageal echocardiography, and to assess their significance in relation to clinical cardioembolic events. BACKGROUND. Strands attached to prosthetic mitral valves are a recently described finding of uncertain clinical significance. There are no reports of strands attached to aortic valve prostheses, and data are limited concerning the relation of valvular strands to cardioembolic events. METHODS. We identified all transesophageal echocardiographic studies performed during a 5-year period at our institution for evaluation of valve dysfunction or a suspected cardioembolic event in patients with a valve prosthesis. All studies were reviewed. The presence of strands was noted and the prevalence compared between patients evaluated for a suspected cardioembolic event and those evaluated for valve dysfunction. In patients with no strands detected, the presence of other potential cardiac sources of embolism was noted. RESULTS. Strands were detected in 56 (26%) of 214 studies. There was a significant difference (p = 0.0001) in the prevalence of strands between studies performed for a suspected cardioembolic event (34 [53%] of 64) versus those performed for suspected valve dysfunction (22 [15%] of 150). Strands were more prevalent on mitral than on aortic valves (32% vs. 13%, p = 0.0004) and were more frequently detected on mechanical than on bioprosthetic valves (27% vs. 8%, p = 0.003). Among patients with a suspected cardioembolic event and normal valves, other potential cardiac sources of embolism were detected in 67%. CONCLUSIONS. Prosthetic valve strands are frequently detected by transesophageal echocardiography. They are more commonly detected in patients being evaluated for a suspected cardioembolic event and thus represent a potential cardiac source of embolism. In patients with apparently normal valves, other potential sources of embolism are frequently detected. Thus, transesophageal echo-cardiography may have a significant impact on the management of these patients.

This article has been cited by other articles:

				J. Almeida, A. Santos, F. Barreiros, M. Garcia, and P. Pinho Stuck leaflet of bileaflet prosthesis in mitral position - five cases to make us think Interact CardioVasc Thorac Surg, June 1, 2007; 6(3): 379 - 383. [Abstract] [Full Text] [PDF]

				M. R. Sohail, D. Z. Uslan, A. H. Khan, P. A. Friedman, D. L. Hayes, W. R. Wilson, J. M. Steckelberg, S. Stoner, and L. M. Baddour Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1851 - 1859. [Abstract] [Full Text] [PDF]

				R. B. A. Van den Brink Evaluation of Prosthetic Heart Valves by Transesophageal Echocardiography: Problems, Pitfalls, and Timing of Echocardiography Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 89 - 100. [Abstract] [PDF]

				S. Homma, M. R. Di Tullio, R. R. Sciacca, R. L. Sacco, J.P. Mohr, and for the PICSS Investigators Effect of Aspirin and Warfarin Therapy in Stroke Patients With Valvular Strands Stroke, June 1, 2004; 35(6): 1436 - 1442. [Abstract] [Full Text] [PDF]

				E. Dumont, C. Camus, F. Victor, C. de Place, D. Pavin, C. Alonso, P. Mabo, and J.C. Daubert Suspected pacemaker or defibrillator transvenous lead infection: Prospective assessment of a TEE-guided therapeutic strategy Eur. Heart J., October 1, 2003; 24(19): 1779 - 1787. [Abstract] [Full Text] [PDF]

				P. Laffort, R. Roudaut, X. Roques, S. Lafitte, C. Deville, J. Bonnet, and E. Baudet Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the st. jude medical prosthesis: A clinical and transesophageal echocardiographic study J. Am. Coll. Cardiol., March 1, 2000; 35(3): 739 - 746. [Abstract] [Full Text] [PDF]

				F Victor, C De Place, C Camus, H Le Breton, C Leclercq, D Pavin, P Mabo, and C Daubert Pacemaker lead infection: echocardiographic features, management, and outcome Heart, January 1, 1999; 81(1): 82 - 87. [Abstract] [Full Text]

				J. K. Roberts, I. Omarali, M. R. Di Tullio, R. R. Sciacca, R. L. Sacco, and S. Homma Valvular Strands and Cerebral Ischemia : Effect of Demographics and Strand Characteristics Stroke, November 1, 1997; 28(11): 2185 - 2188. [Abstract] [Full Text]

				S. Pamidi, P. J. Leo, B. Saul, J. Gelles, D. Chu, and P. J. Leo Postoperative Mitral Valve Abscess: A Case Report Angiology, August 1, 1997; 48(8): 749 - 752. [Abstract] [PDF]

				A. Cohen, C. Tzourio, C. Chauvel, B. Bertrand, I. Crassard, Y. Bernard, L. Goullard, S. Falcon, M.-G. Bousser, and P. Amarenco Mitral Valve Strands and the Risk of Ischemic Stroke in Elderly Patients Stroke, August 1, 1997; 28(8): 1574 - 1578. [Abstract] [Full Text]

				F. D. Tice, A. P. Slivka, E. T. Walz, D. A. Orsinelli, and A. C. Pearson Mitral Valve Strands in Patients With Focal Cerebral Ischemia Stroke, July 1, 1996; 27(7): 1183 - 1186. [Abstract] [Full Text]