Philippe Rheault1, Siamak Mohammadi2, Kim O’Connor1, François Dagenais2, Pierre Voisine2, Sébastien Bergeron1, Mathieu Bernier1, Christian Couture3, Paul Poirier1, Alexandre Cinq-Mars4, Michelle Dubois4, Mario Sénéchal1,51Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
2Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
3Anatomo-Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
4Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
5Electronic correspondence: email@example.com
Background and aim of the study: The unique design of the Freestyle stentless aortic bioprosthesis has led to different mechanisms of failure, particularly leaflet tearing. The aim of this retrospective study was to review the clinical presentation and echocardiographic data of symptomatic patients with leaflet tears and significant aortic regurgitation (AR) following implantation of the Freestyle bioprosthesis.
Methods: Between January 1993 and May 2011, a total of 430 consecutive patients was identified at the authors’ institution who had undergone primary aortic valve replacement with a Freestyle stentless aortic bioprosthesis. Clinical and echocardiographic data were collected prospectively for all patients. Structural valve deterioration was the major cause of bioprosthetic valve failure.
Results: Twenty symptomatic patients presented with significant AR due to leaflet tears in the absence of more
than mild valvular calcification. At presentation, all patients complained of dyspnea. Some 50% of patients (n = 10) presented with acute pulmonary edema, and 10% (n = 2) with cardiogenic shock. A leaflet tear was initially diagnosed using transthoracic echocardiography in five cases (25%), using transesophageal echocardiography (TEE) in eight cases (40%), or at surgery in seven cases (35%). An appropriate diagnosis of leaflet tearing was recognized at surgery in more than one-third of patients. Consequently, clinicians must be aware of the variety of clinical presentations and should have a high degree of suspicion regarding leaflet tears in patients who have received a Freestyle stentless aortic bioprosthesis and present with moderate to severe AR.
Conclusion: For the optimal management of patients with Freestyle stentless aortic bioprosthesis and new moderate to severe AR, TEE should be considered in all patients.
The Journal of Heart Valve Disease 2016;25:628-633
|Clinical Presentation and Value of Echocardiography in the Diagnosis of Freestyle Aortic Bioprosthesis Leaflet Tears: A Retrospective Study|
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