BPVT versus degeneration: Echocardiography

(Panels A and B) Typical appearance of BPVT on echocardiography. In this patient, aortic prosthetic mean gradient increased to 46 mmHg 2 years after surgical implantation. TEE short-axis images (panel A) show relative sparing of the cusp edges, but overall opening of the valve is reduced. On long-axis views (panel B) there is visible thickening of the body of the prosthetic cusp, with an echo intensity similar to cusp or soft tissues. There is reduced mobility of the leaflets at the affected sites. With warfarin anticoagulation, the mean gradient decreased to 28 mmHg at 1 month and 14 mmHg at 6 months.
(Panels C and D) Typical appearance of bioprosthetic degeneration on echocardiography. In this patient, aortic prosthetic mean gradient increased to 37 mmHg 4 years after surgical implantation. TEE short axis (panel C) shows echo-bright, fused left and noncoronary cusps (arrows). TEE long axis (panel D) shows the echo-bright, immobile posterior cusp. The anterior cusp is mobile and thin (arrow). Note in both short- and long-axis views that signal intensity in the affected cusps is similar to the one in the prosthetic struts, and higher than the unaffected cusp or soft tissues. This patient underwent surgical re-replacement. The pathology specimen from this patient confirmed the echo findings and is presented in the dedicated figure.