VALUE AND LIMITATIONS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN EVALUATING PROSTHETIC OR BIOPROSTHETIC VALVE DYSFUNCTION

Optimal management of patients with prosthetic heart valves requires serial assessment of valve function. The addition of Doppler and color flow techniques to conventional transthoracic echocardiography (TTE) has increased our ability to evaluate prosthetic valve function. However, the sensitivity of TTE remains limited in a number of patients because of suboptimal precordial windows or because of ultrasound interference with the nonbiologic materials composing the prostheses.1-3 Transesophageal echocardiography (TEE) allows excellent imaging resolution of the cardiac anatomy without interposition of thoracic structures. Recently, TEE has been shown to increase the yield of undetected prosthetic valve abnormalities by TTE.4-8 However, most of the TEE information relates to biologic prostheses in the mitral position.5-8 Thus, the purpose of this study was to investigate the diagnostic accuracy of TEE in evaluating mechanical and biologic prostheses in both aortic and mitral positions, and the impact of the TEE information on the clinical outcome. © 1992.