Intracavitary Echoes in Patients with Mitral Prosthetic Valves
In routine echocardiograms on Datients with mitral prosthetic valves we observed pecular intracavitary echoes within the left ventricle. The echoes aDDeared as very fine lines which seemed to move toward the transducer during diastole and away from the transducer axis with systole. The echoes were seen best with the transducer near the cardiac apex and angled superiorlv and medially so that the ultrasonic beam was essentially in the long axis of the moving prosthetic ball. Of the 35 valves studied in 30 different patients, 13 echo-cardiograms demonstrated the abnormal echoes and 22 did not. The presence of mitral insufficiency, atrial fibrillation, systemic emboli, and warfarin sodium were roughly equal in the two groups. A higher percentage of patients with a hemoglobin less than 11 gm%, other prosthetic valves, cloth covered valves, low platelets, and functional class III-IV had the abnormal intracavitary echoes. The only patient without a prosthetic valve who has had similar echoes had disseminated intravascular clotting. Although this study does not clarify the origin of these abnormal echoes, the data suggest that they originate from small particulate matter such as tinv fibrin clots from the prosthetic valve.