From the Departments of Neurology, Universities of Halle and Jena, Halle
and Jena, Germany.
Correspondence to D. Georgiadis, MD, Department of Neurology, University of Halle, D-060129 Halle, Germany. E-mail dimitrios.georgiadis{at}medizin.uni-halle.de
Background—The clinical relevance of
Doppler microembolic signals (MES) in patients with
prosthetic cardiac valves was evaluated by merging and
statistically reanalyzing patient data from four research institutions
(Departments of Neurology, Universities of Aachen, Halle, and
Münster, Germany; Department of Medicine and Therapeutics,
University of Glasgow, Scotland, and Department of Cardiothoracic
Surgery, Western Infirmary, Glasgow, Scotland).
Methods—Transcranial Doppler monitoring for MES
was performed over the middle cerebral arteries for 30 to 60 minutes
per patient. Prevalence of neurological complications was evaluated
with a standard neurological questionnaire in patients carrying the
valve implant longer than 3 months (n=369).
Results—Significant differences in MES prevalence and counts were
noted among the 580 patients depending on valve type (presented with
medians and [95% confidence intervals]): St Jude Medical, n=200,
72%, 4 [3 to 6]; Björk Shiley Monostrut, n=99, 92%, 133 [93
to 181]; Medtronic Hall, n=80, 47%, 1 [2 to 5]; ATS, n=61, 52%, 3
[2 to 5]; Tecna, n=38, 71%, 2 [1 to 4]; Carbomedics, n=37, 81%, 8
[5 to 13]; Carpentier-Edwards supraannular, n=54, 39%, 1 [0 to 3];
Sorin biological, n=11, 9%, 0 [0 to 0]. No relation between MES
counts and valve size, international normalized ratio, patients' age,
cardiac rhythm, or implant duration was noted. No significant
differences in MES counts or prevalence (22 [3 to 68] versus 5 [3 to
6] and 63% versus 69%, both P>.05), in valve
duration, valve position, valve type, patients' age, sex, cardiac
rhythm, or international normalized ratio were evident between
neurologically symptomatic (n=42) and
asymptomatic patients.
Conclusions—MES in patients with prosthetic cardiac
valves depend on the type and, in certain valve types, the position of
the valve implant and possess no direct clinical significance.
© 1998 American Heart Association, Inc.
Original Contributions
Clinical Correlations of Doppler Microembolic Signals in Patients With Prosthetic Cardiac Valves
Analysis of 580 Cases
Key Words: embolism • heart valve prosthesis • ultrasonics
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