Transesophageal echocardiographic features of stenotic bioprosthetic valves in the mitral and tricuspid valve positions

A frequent long-term complication of bioprosthetic valves is spontaneous degeneration of the cusps with clinical features of valve regurgitation or, less frequently, valve stenosis.1 Transthoracic echocardiography with cardiac Doppler is valuable in diagnosing stenosis of bioprosthetic valves.2 However, a major drawback of this approach is that all 3 bioprosthetic cusps are not consistently demonstrated owing to sound attenuation from the intervening chest wall and lungs, and to reverberation from the metal portion of the valve ring and stents. These problems are usually overcome by using a transesophageal ultrasound probe. We recently described our transesophageal echocardiographic investigations in predominantly regurgitant bioprosthetic valves.3 Those patients are not included in this study. To the best of our knowledge, there are no reports on stenotic bioprostheses studied by transesophageal echocardiography.