Trombose de prótese biológica mitral: importância do ecocardiograma transesofágico no diagnóstico e acompanhamento pós-tratamento

Abstract

To report the clinical and echocardiographic findings of bioprosthetic mitral valve thrombosis and the value of transesophageal echocardiography (TEE) in its diagnosis and monitoring of thrombolysis. One hundred and eleven patients with mitral bioprostheses underwent TEE, and 4 out of 7 suspected of having a thrombus on these prostheses were included in the study (mean age = 60.2+/-10.2 years; 2 men). The diagnosis was confirmed with serial TEE and clinical evolution. The morphologic features of the prosthetic leaflets, as well as the presence and characteristics of attached echogenic masses were investigated. The mean gradient through the prosthesis and the valvular area were obtained. The diagnosis of bioprosthetic mitral valve thrombosis was established 48.7+/-55.2 months after surgery. Two patients had ischemic stroke in the early postoperative period. The mean overall gradient was high (11.4+/-3 mmHg) and the valvular area reduced (1.24+/-0.3 cm2). On TEE, echogenic masses on the left ventricular face of the mitral bioprosthesis suggestive of thrombus were evidenced in all patients. On serial TEE (136+/-233 days), in 2 patients the thrombus had disappeared and in 2 others it was smaller after treatment, the mean gradient dropped to 6.2+/-3 mmHg (P = 0.004; 95% CI), and the valvular area increased to 2.07+/-0.4 (P = NS). TEE proved to be useful for detecting bioprosthetic mitral valve thrombosis and was effective in monitoring the treatment in all patients.