| Prosthetic mitral regurgitation can be mimicked by Doppler color flow mapping: avoiding misdiagnosis. | |
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MedLine Citation:
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PMID: 15282485 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to characterize a region of apparent systolic flow resembling mitral regurgitation (MR) in patients with mechanical disk mitral prostheses as artifact. BACKGROUND: Diagnosing MR in the presence of mechanical prostheses is challenging. Occasionally, important MR is suggested by a substantial region of systolic Doppler color flow in an acoustically shadowed region of the left atrium when, in fact, only trace MR exists. We hypothesized this pseudo-MR is caused by acoustic mirroring of the left ventricular outflow tract (LVOT) flow by sound reflected off the prosthesis, projecting flow into the left atrium because of longer transit time. METHODS: We reviewed 19 patients with mechanical mitral valves and trace MR by transesophageal echocardiography who had transthoracic echocardiography studies within 1 week (group A), and prospectively studied 22 consecutive patients by transthoracic echocardiography with subtle transducer angulation variation to detect pseudo-MR and characterize it by pulsed Doppler (group B). RESULTS: In group A, 12 of 19 patients had evidence of pseudo-MR on review of their transthoracic echocardiograms, absent by transesophageal echocardiography. In group B, this pseudo-MR signal was present in 13 of 22 patients, with velocity and timing by pulsed Doppler comparable with LVOT flow (onset at 125 +/- 27 milliseconds vs 135 +/- 11 milliseconds from QRS, P = not significant). The angle between the mitral plane and the LVOT, which determines whether this mirroring can occur, was smaller for patients with pseudo-MR. CONCLUSION: Artifactual pseudo-MR is often seen with mechanical mitral prostheses. Its behavior and sensitivity to geometric relationships are consistent with mirroring of LVOT flow. Practically, potential misdiagnosis can be readily avoided by pulsed Doppler sampling, sparing the patient further procedures. |
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Authors:
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Lawrence G Rudski; Chi-Ming Chow; Robert A Levine |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Volume: 17 ISSN: 0894-7317 ISO Abbreviation: J Am Soc Echocardiogr Publication Date: 2004 Aug |
Date Detail:
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Created Date: 2004-07-29 Completed Date: 2004-11-16 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8801388 Medline TA: J Am Soc Echocardiogr Country: United States |
Other Details:
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Languages: eng Pagination: 829-33 Citation Subset: IM |
Affiliation:
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Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Artifacts* Chi-Square Distribution Diagnostic Errors Echocardiography, Doppler, Pulsed* Echocardiography, Transesophageal Female Heart Valve Prosthesis* Humans Male Middle Aged Mitral Valve / ultrasonography* Mitral Valve Insufficiency / ultrasonography* Prospective Studies Retrospective Studies Systole |
| Grant Support | |
ID/Acronym/Agency:
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HL 38176/HL/NHLBI NIH HHS; HL 53702/HL/NHLBI NIH HHS; HL 67434/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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