Clinical and echocardiographic evaluation of the St. Jude cardiac valve prosthesis: follow-up of 126 patients.

One hundred twenty-six patients with a St. Jude valve prosthesis were followed up clinically and studied by combined M-mode echocardiography and phonocardiography. Fifty patients underwent aortic valve replacement, 58 underwent mitral valve replacement and 18 underwent a combination of the two. The early postoperative mortality rate was 8% for aortic, 6.9% for mitral and 6% for combined valve replacement. Follow-up ranged from 2 to 46 months (mean +/- SD 28 +/- 9). The late postoperative mortality rate was 5%; in patients who survived, improvement in New York Heart Association functional class occurred in 97%. Major thromboembolic events occurred in two patients and anticoagulation-related complications occurred in three patients. Valve-related complications occurred in 14 patients and included bacterial endocarditis (6 patients), paravalvular leak (5 patients), severe hemolysis (1 patient), thrombosis of valve (1 patient) and possible mechanical valve failure (1 patient). In 7 of these 14 patients, repeat surgery was required and 5 patients survived. Abnormal echocardiographic findings in these seven patients included a shortened aortic closure (A2) to mitral valve opening interval, increased left atrial and left ventricular size and initial diastolic rounding of the St. Jude valve motion in the patient with the thrombosed valve. It is concluded that the St. Jude valve prosthesis is associated with favorable functional results and a low complication rate for a mean follow-up period of 28 months. Combined M-mode echocardiography and phonocardiography may be useful in assessing patients with suspected complications related to the St. Jude cardiac valve.