Cineradiographic evaluation of prosthetic cardiac valves.

SUMMARY Forty-nine patients whose clinical symptoms suggested a leaking cardiac prosthetic valve were studied by both cineradiography and angiocardiography. We found a wider range of tilting motion of the nonleaking mitral valve than has been previously shown. An angle of tilt greater than 60 for the prosthetic aortic valve strongly suggests separation of the prosthesis from its bed with a para-valvular leak, while the angle of tilt suggestive of a paravalvular leak for a prosthetic mitral valve is 12°. However, a tilt of less than these values does not entirely exclude the existence of a leak. We strongly suggest that routine cineradiography be done in each patient shortly after surgery, as a basis for comparison if the patient later develops a murmur or congestive heart failure. Aortic valve, prosthetic Paravalvular leak Mitral valve, prosthetic Angiocardiography THE USE OF PROSTHETIC CARDIAC VALVES has become commonplace. Occasionally , these patients do poorly postoperatively as a result of leaking around the prosthetic valve ring. These paravalvular leaks are often difficult to detect clinically1' 2, 3,4 Cineradiography has been used by Bjork and Bjork8 to study the motion of prosthetic aortic valves, and by Gimenez et al.5 to study prosthetic aortic and prosthetic mitral valves. These authors defined the range of angular tilting motion for nonleaking valves, and pointed out that a paravalvular leak can cause an increased tilting motion. To date, these findings have not been confirmed with angiography in most cases. The present study was undertaken to evaluate the usefulness of cineradiographic examinations of prosthetic cardiac valves and to further define the normal range of motion of these valves using asetts. 882 Valvular tilt relatively large series of patients, all angiograph-ically proven. Materials and Methods This series consists of analyses of cineradiographic and angiographic studies of 49 patients with Starr-Edwards prosthetic cardiac valves, examined between 1967 to 1970 in the Cardiac Catheterization Laboratory of the Massachusetts General Hospital, for the clinical suspicion of a leaking prosthetic valve. Cineradiographic examinations were perforned in left anterior oblique, anteroposterior, and a right anterior oblique projections with suspended respiration. A six-inch image amplifier with 35 mm cineradiography was used. The degree of tilt of the valve along its long axis was measured on successive frames of the cineradio-graphic film strip, when projected frame by frame. (fig. 1-4) The maximum degree of tilt irn each of these three projections was recorded (table 1). The largest of these …