Objectives The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD).

Background Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation.

Methods The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50% increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation.

Results There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65%). The prosthesis positions were aortic 56%; mitral 26%; tricuspid 15%; and pulmonary 3%. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88%) versus 20 of 188 (11%) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81% of BPVT and 90% of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001).

Conclusions Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.

目的本研究的目的是回顾经胸超声心动图（TTE）的诊断早期人工瓣膜功能障碍（PVD）的制度实践。

背景技术人工瓣膜血栓形成（BPVT）是PVD的重要原因，并且指南不建议在瓣膜植入后的前5年进行常规TTE。

方法作者对1997年1月至2016年12月期间所有疑似（影像学诊断）或确诊（组织病理学诊断）的BPVT病例进行了回顾性病例对照研究。患者的年龄，性别，假体位置按比例1：2匹配由于结构衰竭（SF），假体被移出。PVD被定义为瓣膜植入时高于基线梯度增加50％，并归类为植入后早期（≤5年）或晚期（> 5年）。

结果BPVT 94例（疑似51例，确诊43例），SF 188例。患者年龄61±9岁；男性61（65％）。假体的主动脉位置为56％。二尖瓣占26％；三尖瓣15％; 和肺3％。与SF组相比，早期PVD在BPVT组中更为常见：94个中的83个（88％）对188个中的20个（11％）（p <0.001）。BPVT从植入到PVD的时间比SF短：26个月（四分位间距[IQR]：12到43个月），而74个月（IQR：48到102个月）（p <0.001）。在最初的PVD诊断中，有81％的BPVT和90％的SF患者无症状。但是，BPVT患者症状迅速恶化，需要在PVD诊断后尽快进行干预：6个月（IQR：4至7个月）与51个月（IQR：22至55个月）（p <0.001）。

结论多数由BPVT引起的PVD患者在初诊时无症状，这是根据常规监测TTE进行的，通常在5年之前进行。BPVT是一种急性疾病过程，需要及时诊断，因为患者的病情会迅速恶化。需要进一步的研究来确定是否应该对有生物瓣膜的患者考虑常规监测TTE，以识别BPVT的症状前特征，以便提供有效，适当的治疗。