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Risk factors for Aortic Valve Peravalvular Leak
EndocarditisEndocarditis calcified annuluscalcified annulus bicuspid aortic valvebicuspid aortic valve
– Note many present with significant Note many present with significant annular calcificationannular calcification
Marfan SyndromeMarfan Syndrome
Rallidis et al (1999)
Studied 84 consecutive patients with aortic valve replacements Patients studied prospectively at early (11days), Mid
(27months) and late (63 months) intervals.
– 40 patients developed leaks early, 90% of these were small and did not change over time. Patients did well.
3 patients developed severe paraprosthetic regurgitation late related to endocarditis one patient had degenerative tissue valve failure.
Concluded: Small leaks usually have a benign course. Development of new severe regurgitation should raise concern of endocarditis or prosthetic valve failure.
DeCicco et al (2005)
Multi centre study:– 1,696 patients undergoing AVR– 39 (2.3%) with paraprosthetic leak
Symptoms in patients with paraprosthetic leak– 71.4% Heart Failure– 17.8% Hemolysis– 10.8% none
28 people underwent surgery– 20/28 valve replaced– 8/28 Prosthetic leak closed by sutures– surgical mortality 7%
Role of Echocardiographer Intraoperatively
Preprocedure:– Assess risk factors for Peravalvular leak
annular calcification endocarditis/abscess
Post aortic valve replacement– Diligently search for Peravalvular leak
– Diligently search for fistula into RA/LA/RVOTEspecially focus in areas of heavy calcium or abscess.
Define location and severity.
Illustration of Aortic Prosthesis Peravalvular Leak
Case #1 Status post placement of prosthetic
peravalvular leak noted immediately post bypass.
Surgeon notified, location defined. Surgeon able to place annular stitches
off bypass. Leak no longer present. (not shown)
Illustration of Aortic Prosthesis Peravalvular Leak
Case #2 58 yr old man presenting with bicuspid
aortic valve with stenosis. Prebypass echo notes severe leaflet
and annular calcification.
Post Bypass Case #2
Note peravalvular leak, adjacent to left main coronary artery.
Peravalvular leak not addressed.
Case #2
Patient returns 3 months later with symptoms.
On echo has peravavluar leak and prolapse prosthetic valve leaflet.
References:
1. DeCicco, Beghi et al: Aortic Valve Periprosthetic Leakage: Anatomic Observations and Surgical Results. Ann Thorac Surg 2005;79:1480-5.
2. Rallidis et al: Natural History of Early Aortic Paraprostheitc Regurgitation: A Five Year Follow-up. Am Heart J 1999 Aug;138(2Pt 1):351-7.
3. O’Rourke et al: Outcome of Mild Periprosthetic Regurgitation Detected by Intraoperative Transesophageal Echocardiography. J Am Coll Card 2001;38:163-6.