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  • Title: [Doppler echocardiography in dysfunctions of valvular prostheses: diagnostic and quantitative significance. Apropos of 20 cases].
    Author: Laflèche A, Verges B, Malergue MC.
    Journal: Arch Mal Coeur Vaiss; 1987 May; 80(5):598-608. PubMed ID: 3113378.
    Abstract:
    We present a retrospective study of 20 patients with cardiac valve prosthetic dysfunction who required reoperation and underwent pre-operative doppler echocardiography. There were 13 cases of mitral valve prosthesis (3 mechanical, 10 xenografts), 5 cases of aortic valve prosthesis (1 mechanical, 4 xenografts), 1 pulmonary valve bioprosthesis and 1 tricuspid valve mechanical prosthesis. Our purpose was to evaluate the diagnostic and quantitative value of this examination in prosthetic dysfunction by comparing doppler data with anatomical findings at surgery. The parameters measured were peak and mean pressure gradients in all cases, gradient half-decrease time and valve surface calculated therefrom in mitral and tricuspid valve prostheses. The results of doppler examination were compared with per-operative anatomical findings in 6 cases, and pre-operative haemodynamic exploration was performed in one case. The diagnosis of prosthetic stenosis was found to be correct in all patients, even in those with moderate stenosis. All leaks and their locations were diagnosed, except in a mitral valve mechanical prosthesis where leaking was detected by continuous doppler. 14 out of the 20 patients were reoperated upon without catheterization. These results suggest that doppler examination is a sensitive and specific method for evaluating cardiac valve dysfunction. However, variations in doppler results from one prosthesis to another make it necessary to perform pulsed and continuous doppler at the end of the operation to be used as reference if dysfunction is suspected subsequently.
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