Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Nov 1991
[Thrombosis of atrioventricular prosthesis. Contribution of transesophageal echocardiography].
The aim of this study was to assess the diagnostic value of transesophageal echocardiography for the detection of thrombosis of a mechanical mitral or tricuspid valve prosthesis. Twelve patients (mean age 54 +/- 12 years) out of a series of 39 patients operated between April 1988 and June 1989 for prosthetic valve dysfunction had valve thrombosis at operation (11 mitral and 1 tricuspid valve prosthesis). Transesophageal echocardiography was routinely performed preoperatively in addition to transthoracic Doppler echocardiography to search for an abdominal mass on the prosthetic valves. ⋯ Eleven of the 12 abnormal masses on the prostheses were visualised by transesophageal echocardiography, a sensitivity of 91%. Detection of the masses on the arterial side was possible in all cases (10/10) but 5 of the 6 extensions of the thrombus into the ventricle could not be visualised. The diameter of the transprosthetic jet was less than 12 mm in 7 of the 8 thrombosed valves compared with greater than 15 mm in the 5 normal control prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical indications of vena cava interruption are reviewed. During the last few years pulmonary embolism frequency remained high and many new percutaneous vena caval filters became available. These facts probably explain the increasing use of these filters reaching about 10,000 filters each year in France. ⋯ The only admitted indications of vena cava interruption, in case of proximal venous thrombosis, are contraindications to anticoagulation. In other situations no data allow to recommend a cava filter; indication will be discussed on a case by case basis. Prospective controlled studies are greatly encouraged.
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Arch Mal Coeur Vaiss · Sep 1991
Case Reports[Late cardiac tamponade by localized compression of the left cavities after heart valve surgery. Apropos of 2 cases].
The authors report two cases of left cardiac failure occurring three and ten months after aortic valve replacement. Echocardiography established the diagnosis of localized compression of left heart chambers by hemopericardium. Surgical drainage dramatically improved patients with a follow-up of 4 years and 18 months. The authors emphasize the interest of left thoracotomy for drainage and discuss the etiology.
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Arch Mal Coeur Vaiss · Apr 1991
[Temporary caval filter allowing diagnosis and fibrinolytic therapy in patients suspect of massive pulmonary embolism].
The authors propose a therapeutic strategy enabling diagnosis, treatment and prevention in the same clinical procedure based on a series of 8 patients presenting with signs of massive pulmonary embolism (acute cardiorespiratory distress, shock, loss of consciousness, and/or cardiac arrest). A removable vena cava filter is rapidly introduced percutaneously via a brachial, femoral or jugular vein, and opened in the inferior vena cava. Using the same catheter and without a second venous puncture, pulmonary angiography and cavography are performed by digitised angiography using a small quantity of contrast medium (40 ml, 12 ml/sec). ⋯ The temporary caval filter was removed in all cases but 3 patients required a definitive filter because of the persistence of life-threatening venous thrombosis. Seven of the 8 patients survived their pulmonary embolism. This approach is rapid, saves time, and spares the patients from more invasive procedures.
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Arch Mal Coeur Vaiss · Apr 1991
Review[Thrombosis of mechanical heart valve prosthesis. Value of transesophageal echocardiography in the study of mitral valve prosthesis].
Forty-three consecutive patients with mechanical valve prostheses underwent transthoracic and transoesophageal echocardiography for suspected thrombolic prosthetic valve dysfunction. The results of these investigations were compared with those of cineradiography and the clinical outcome. The diagnosis of thrombosis was retained in 11 of the 43 patients (10 mitral and 1 aortic valve prostheses). ⋯ The cineradiography gave false negative results in 6 cases. In conclusion, these cases underline the undeniable value of transoesophageal echocardiography in occlusive or non-occlusive thrombosis of a mitral valve prosthesis. This investigation should be undertaken whenever there is the least suspicion of thrombosis of the prosthesis.