1 From the Departments of Medicine (Cardiology), Radiology and Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Assessment of left ventricular outflow tract (LVO) width was made from preoperative mitral valve echocardiograms in 26 patients with pure or predominant mitral stenosis who later had valve replacement. LVO width was measured as the minimum space between the ventricular septal echo and the anterior mitral leaflet at beginning systole. Prosthesis encroachment on LVO (PE) was estimated by comparing the length of the poppet expected to protrude into the LVO in systole with LVO width determined by ultrasound (poppet length/LVO width x 100). Group 1 (12 patients) had normal LVO widths (
Submitted on May 14, 1973
© 1973 American Heart Association, Inc.
Echocardiographic Assessment of Left Ventricular Outflow Width in the Selection of Mitral Valve Prosthesis
20 mm) and received Starr-Edwards prostheses. There was one in-hospital death in this group. Group 2 (seven patients) had narrow LVO (<20 mm) and also received Starr-Edwards prostheses. Five patients died, four of them due to low cardiac output syndrome. Group 3 (seven patients) also had narrow LVO, but Cross-Jones disc prostheses were used. Only one died. The high mortality in Group 2 appears to be related to obstruction of LVO by the caged ball prosthesis; PE in this group ranged from 60% to 80% while it was less than 50% in all but two patients in Group 1. A low profile prosthesis appears desirable when the LVO width measures <20 mm by echocardiography.
Key Words: Echocardiography • Cross-Jones prosthesis • Starr-Edwards prosthesis • Mitral valve echocardiogram • Low cardiac output syndrome • Mitral stenosis
Accepted on July 26, 1973