Obstruction of the St. Jude Medical Valve - Diagnostic and Therapeutic Values of Cineradiography

Summary

Between 1984, and 1992, we observed 8 patients with an ob structed St. Jude Medical (SJM) valve. Of these, 1 had an ob structed SJM valve in the aortic Position, 3 in the mitral posi tion, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cin eradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cin eradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, lea flet function in the obstructed SJM valve was strikingly abnor mal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 under went urgent prosthetic valve replacements after cineradio graphy and echocardiography were carried out. Thrombolysis using Urokinase was performed in 4 patients, and this treat-ment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat cineradiography. Three of the 4 patients who received thrombolysis showed no signifi cant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function. Al though thrombolytic therapy is considered the first choice of treatment for obstructed SJM valve in selected patients, pa tients who do not respond to thrombolytic therapy within 48-72 hours should be referred for surgery.

Zusammenfassung

Es wird von über 8 Patienten mit thrombotisch obstruierter St. Jude Medical Klappe (SJM) berichtet, von denen 4 notfall mäßig operiert und 4 einer Thrombolyse unterworfen wurden; diese war jedoch nur in 1 Fall an der Tricuspidalis erfolgreich, in den 3 anderen Fällen mußte dann auch operiert worden. Viermal war die Tricuspidalklappe, dreimal die Mitralklappe und einmal die Aortenklappe betroffen. Die Diagnose wurde jeweils mittels Cineradiographie und Echokardiographie ge stellt. An 70 anderen Patienten mit einer normalen SJM-Klap pe wurde die Beweglichkeit der Klappenscheiben mittels kon ventioneller Cineradiographie ausgemessen und mit den 8 Pa tienten verglichen. Die Autoren betrachten die Kombination von Cineradiographie und Echokardiographie als die optimale diagnostische Methode zur Erkennung der Klappenobstruk tion, aber auch zur Überprüfung des Erfolgs einer thromboly tischen Behandlung.

Key words

Cineradiography - St. Jude Medical valve - Thrombolysis - Valve thrombosis - Valve obstruction