Intraoperative echocardiographic detection of regurgitant jets after valve replacement

Background. Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown. Methods. Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type. Results. Before protamine, 55 jets were identified (2.04 ± 1.4 per patient) versus 29 jets after (1.07 ± 1.2 per patient, p = 0.0002). Total jet area improved from 2.0 ± 2.2 cm2 to 0.86 ± 1.7 cm2 with protamine (p< 0.0001). In all patients jet area decreased (average decrease, 70.7% ± 27.0%). First time and redo operations had similar improvements in jet number and area (both p> 0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively. Conclusions. Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.