Editorial
Should we ever treat the echo rather than the patient?
| The first 150 words of the full text of this article appear below. |
It is not unusual to find a Doppler derived peak gradient of 40 mm Hg across a Bjork-Shiley valve in the aortic position. However, in the case reported below1 further investigation led to the identification of thrombus, and the patient underwent reoperation despite being asymptomatic. Should this case affect our management of mechanical valves?
Most centres perform routine postoperative echocardiography. This is
useful to compare with future studies as a new paraprosthetic leak may
be a sign of endocarditis, and a major change in forward flow pattern
may support the clinical suspicion of obstruction. However, published
guidelines2 3 do not recommend further studies unless the
patient has symptoms or there is clinical suspicion of valve
dysfunction. According to these guidelines, the study ultimately
leading to surgery in this patient need not have been performed. We do
not know if this would have mattered. The patient might have remained
asymptomatic. Alternatively, the thrombosis could
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Echocardiography
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