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Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters

John Barbetseas, MD^* , Sherif F. Nagueh, MD, FACC^*, Christos Pitsavos, MD, Pavlos K. Toutouzas, MD, FACC, Miguel A. Quiñones, MD, FACC^* and William A. Zoghbi, MD, FACC^*

^* Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA
Department of Cardiology, Athens University, Hippokration Hospital, Athens, Greece

View larger version (10K): [in a new window]   Figure 1 Plots of total mass length (top) and total mass area (bottom) of the 13 thrombi and 7 pannuses that were identified by TEE.

View larger version (88K): [in a new window]   Figure 2 Transesophageal echocardiogram showing a thrombus (large arrows) visualized as a soft mass on the atrial side of a bileaflet mitral prosthetic valve. There is extension of the thrombus to the left atrial wall. Small arrows indicate the level of the prosthesis. Ao = aorta; PrV = prosthetic valve; Th = thrombus.

View larger version (86K): [in a new window]   Figure 3 Transesophageal echocardiogram showing a pannus (large arrows) visualized as a dense mass on a tilting-disc aortic prosthesis. Small arrow indicates the valve ring. LA = left atrium; LV = left ventricle; Pn = pannus; PrV = prosthetic valve.

View larger version (88K): [in a new window]   Figure 4 Transesophageal echocardiogram showing a pannus (arrow) visualized as a soft mass on a bileaflet aortic prosthesis. LA = left atrium; Pn = pannus.

View larger version (13K): [in a new window]   Figure 5 Plots of the ultrasound videointensity ratio in the 13 thrombi and 7 pannuses that were visualized by TEE.

View larger version (19K): [in a new window]   Figure 6 Receiver-operator curve for prediction of thrombus using the ultrasound videointensity ratio. UVI = ultrasound videointensity.