Author + information
- Received May 23, 2014
- Revision received June 16, 2014
- Accepted June 19, 2014
- Published online June 1, 2015.
- Paul C. Cremer, MD∗,
- L. Leonardo Rodriguez, MD∗,
- Brian P. Griffin, MD∗,
- Carmela Tan, MD†,
- Rene Rodriguez, MD†,
- Douglas R. Johnston, MD‡,
- Gosta B. Pettersson, MD‡ and
- Venu Menon, MD∗∗ ()
- ∗Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- †Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ‡Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. Venu Menon, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195.
In older adults, bioprosthetic valves rarely fail within 5 years of the index surgery. Such failures pose a challenge to patients, clinicians, and surgeons. Although clinicians are generally aware of valve dysfunction related to overt endocarditis, patient–prosthesis mismatch, and technical error, less-recognized causes of early bioprosthetic valve failure include valve thrombosis (Figures 1 and 2⇓⇓, Online Videos 1 and 2), excessive pannus formation (Figures 3 and 4⇓⇓, Online Videos 3, 4, 5, and 6), and accelerated structural valve deterioration (Figures 5 and 6⇓⇓, Online Videos 7, 8, 9, and 10). Given their rarity, these failure mechanisms have not been well characterized, and echocardiographic features that may aid in diagnosis are sparse. In this pictorial essay, we highlight these lesser-known causes of early bioprosthetic valve failure. By recognizing simple echocardiographic findings within a clinical context, the correct diagnosis for these infrequent presentations can be ascertained (Figure 7).
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 23, 2014.
- Revision received June 16, 2014.
- Accepted June 19, 2014.
- American College of Cardiology Foundation