Clinical, Echocardiographic, and Pathologic Features of Aortic Wall Dehiscence of Porcine Bioprosthetic Valves: A Cause of Rapidly Progressive Mitral.

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Presentation transcript:

Clinical, Echocardiographic, and Pathologic Features of Aortic Wall Dehiscence of Porcine Bioprosthetic Valves: A Cause of Rapidly Progressive Mitral Regurgitation and Heart Failure After Bioprosthetic Mitral Valve Replacement Tasneem Z. Naqvi, MD, MRCP, Robert J. Siegel, MD, FACC, Neil A. Buchbinder, MD, FACC, Michael C. Fishbein, MD, FACC Journal of the American Society of Echocardiography Volume 11, Issue 7, Pages 720-728 (July 1998) DOI: 10.1053/je.1998.v11.a90296 Copyright © 1998 American Society of Echocardiography Terms and Conditions

Fig. 3 Left anterior oblique ventriculogram (a) showing severe MR opacifying the left atrium and pulmonary veins (arrows) in patient 5. Gross pathology of the explanted mitral Carpentier-Edwards bioprosthesis shows a single large dehiscence (asterisk), with otherwise normal valve morphology. Journal of the American Society of Echocardiography 1998 11, 720-728DOI: (10.1053/je.1998.v11.a90296) Copyright © 1998 American Society of Echocardiography Terms and Conditions

Fig. 1 Apical four-chamber view showing two-dimensional (a and d) and color Doppler echocardiographic findings (b and e) and gross pathology (c and f) of mitral bioprostheses showing dehiscence of the aortic wall from the stent posts of Hancock bioprosthesis in case 1 (left) and Carpentier-Edwards bioprosthesis in case 2 (right). Prolapse of the anterior mitral valve leaflet (solid arrowhead) is shown on two-dimensional echocardiography in an apical four-chamber view on TTE. Eccentric posteriorly directed MR jet (open arrows) is shown in patient 1 (b) and central MR in patient 2 (e). Ventricular (outflow) view of the explanted valves shows commissural dehiscence of the aortic wall from two stent posts (asterisks) in case 1 and from all three stent posts (asterisks) in case 2. The torn edge of the dehisced aortic wall shows an irregularly scalloped edge (black arrow). Journal of the American Society of Echocardiography 1998 11, 720-728DOI: (10.1053/je.1998.v11.a90296) Copyright © 1998 American Society of Echocardiography Terms and Conditions

Fig. 2 Three-chamber views on TEE showing two-dimensional (a and d) and color Doppler echocardiographic findings (b and e) and gross pathology of the explanted valves (c and f) showing dehiscence of the aortic wall from the anteriorly positioned stent in the commissural area in Carpentier-Edwards bioprosthesis in case 4 (left) and Hancock bioprosthesis in case 3 (right). Prolapse of the anterior valve leaflet (solid arrowhead) is shown on two-dimensional view. Eccentric posteriorly directed MR jet caused by prolapsing anterior leaflet is readily apparent. Ventricular (outflow) view of the explanted valves shows thin margins of the torn aortic wall (arrow) caused by acute commissural dehiscence from a single stent post with otherwise normal valve in case 4. The underlying Dacron mesh (asterisk) of the bioprosthesis is visible. Thickened, more smooth margins of the torn aortic wall caused by chronic commissural dehiscence from two struts (asterisk) is shown in case 3. Thickened valve leaflets along with “strut creep” is present. Journal of the American Society of Echocardiography 1998 11, 720-728DOI: (10.1053/je.1998.v11.a90296) Copyright © 1998 American Society of Echocardiography Terms and Conditions

Fig. 4 Diagrammatic representation of a Carpentier-Edwards bioprosthetic valve illustrating dehiscence of cuspal tissue from its stent post (asterisk). During manufacture, portions of the outer aortic wall are removed to enhance valve orifice size. Dehiscence of porcine aortic valve cuspal tissue from its stent post includes both valve cusp and aortic wall remnant. Journal of the American Society of Echocardiography 1998 11, 720-728DOI: (10.1053/je.1998.v11.a90296) Copyright © 1998 American Society of Echocardiography Terms and Conditions