Skip to main content
Erschienen in:

20.09.2017 | Case image in cardiovascular ultrasound

Paravalvular leakages between sewing cuffs after the second surgery for double valve replacement: evaluation by three-dimensional color-Doppler transesophageal echocardiography

verfasst von: Hideta Takushi, Akihiro Hayashida, Nobuyuki Kagiyama, Misako Toki, Atsushi Hirohata, Keizo Yamamoto, Kiyoshi Yoshida

Erschienen in: Journal of Echocardiography | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Excerpt

An 86-year-old woman was admitted for dyspnea on effort. She had previously undergone double valve replacement (DVR) at 57 years of age because of rheumatic valvular heart disease and re-do DVR at age 69 years. Her hemoglobin level was low (6.6 g/dl) and lactate dehydrogenase level was elevated (1692 IU/l). The 12-lead electrocardiogram showed atrial fibrillation. The chest radiograph revealed a 77% cardio-thoracic ratio. Transthoracic echocardiography (TTE) could not detect any paravalvular leakages (PVLs) because of the acoustic shadow of the mitral prosthesis (Fig. 1a, b). Although transesophageal echocardiography (TEE) could detect mitral regurgitation, we originally thought she had transvalvular leakage, which had seemed to be inside the mitral annulus (Fig. 1c, d). We found that a down-sized 25-mm St. Jude Medical (SJM) mechanical prosthesis had been inserted instead of a 27-mm Björk-Shiley (BS) mechanical prosthesis. The previous sewing cuff of the 27-mm BS mechanical prosthesis remained, and the 25-mm SJM mechanical prosthesis had been inserted inside it (Fig. 1e). Three-dimensional color-Doppler TEE finally detected PVLs between the sewing cuffs, which can cause hemolytic anemia and heart failure (Fig. 1f–h). Her condition was difficult to treat because of old age and frailty; she has been followed up with monthly blood transfusions.
Literatur
1.
Zurück zum Zitat Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89:1316–21.CrossRefPubMedPubMedCentral Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89:1316–21.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Kliger C, Eiros R, Isasti G, et al. Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure. Eur Heart J. 2013;34:638–49.CrossRefPubMed Kliger C, Eiros R, Isasti G, et al. Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure. Eur Heart J. 2013;34:638–49.CrossRefPubMed
3.
Zurück zum Zitat Kronzon I, Sugeng L, Perk G, et al. Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol. 2009;53:1543–7.CrossRefPubMed Kronzon I, Sugeng L, Perk G, et al. Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol. 2009;53:1543–7.CrossRefPubMed
4.
Zurück zum Zitat Arribas-Jimenez A, Rama-Merchan JC, Barreiro-Pérez M, et al. Utility of real-time 3-dimentional transesophageal echocardiography in the assessment of mitral paravalvular leak. Circ J. 2016;80:738–44.CrossRefPubMed Arribas-Jimenez A, Rama-Merchan JC, Barreiro-Pérez M, et al. Utility of real-time 3-dimentional transesophageal echocardiography in the assessment of mitral paravalvular leak. Circ J. 2016;80:738–44.CrossRefPubMed
5.
Zurück zum Zitat Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the task force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.CrossRefPubMed Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the task force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.CrossRefPubMed
Metadaten
Titel
Paravalvular leakages between sewing cuffs after the second surgery for double valve replacement: evaluation by three-dimensional color-Doppler transesophageal echocardiography
verfasst von
Hideta Takushi
Akihiro Hayashida
Nobuyuki Kagiyama
Misako Toki
Atsushi Hirohata
Keizo Yamamoto
Kiyoshi Yoshida
Publikationsdatum
20.09.2017
Verlag
Springer Japan
Erschienen in
Journal of Echocardiography / Ausgabe 1/2018
Print ISSN: 1349-0222
Elektronische ISSN: 1880-344X
DOI
https://doi.org/10.1007/s12574-017-0353-5

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Kardiologie

Vier-Punkte-Regel zum Abbruch der Reanimation

Für die Beendigung von Wiederbelebungsmaßnahmen nach Herzstillstand in Kliniken schlägt ein internationales Team eine Vier-Punkte-Regel vor. Deren Zuverlässigkeit wurde in einer skandinavischen Kohortenstudie validiert.

Welche Faktoren das Demenzrisiko bei Vorhofflimmern beeinflussen

In einer Metaanalyse wurden elf Faktoren identifiziert, die bei Vorhofflimmern(VHF)-Patienten mit dem Risiko für eine kognitive Beeinträchtigung assoziiert sind. Im besten Fall eröffnet sich damit ein Weg für die Prävention.

TSAT bester Marker für Herzinsuffizienz-Prognose?

Um Herzinsuffizienz-Kranke zu erkennen, die aufgrund eines Eisenmangels eine schlechtere Prognose haben, scheint die Transferrin-Sättigung (TSAT) besonders geeignet zu sein. Sie ist offenbar aussagekräftiger als der Ferritinwert.

Prävention von Aortenaneurysmen: Auf Lipidsenker setzen?

Lipidsenker scheinen einen signifikanten Schutz vor Erkrankungen der Aorta zu bieten. Das geht aus einer umfangreichen Analyse von Biobank- und Pharmakovigilanz-Daten hervor. Antihypertensiva bewirken da offenbar weniger.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.