M-Mode and 2-dimensional echocardiographic characteristics of the Ionescu-Shiley valve in the mitral and aortic positions.

Using M-mode and 2-dimensional (2-D) echocardiography, ultrasonic features of the Ionescu-Shiley valve were characterized. A number 23 prosthesis was placed in a saline-filled chamber and subjected to pulsatile flow. Production of a linear tear at the base of a cusp resulted in coarse fluttering in the open position, and there was a reduction in the anterior cusp slope. Partial detachment of a cusp from its stent produced high-amplitude low-frequency fluttering during ejection. Alteration of transducer position eliminated the abnormal echoes. Fourteen patients with aortic and 11 with mitral prostheses were studied. There was a close approximation of echographically determined values for the bare stent internal diameter, cusp excursion, and valve orifice diameter compared with the manufacturer's specifications. Random punctiform echoes were noted when the cusps opened. Cusp echoes were superimposed on stent echoes in 21% of patients, and a third cusp was detected in 29%. Two-dimensional echocardiograms of good quality were recorded in the vast majority of subjects. Cusp echoes were smooth and had a consistent motion in both the short and longitudinal axis. Multiple transducer positions were required to delineate prosthetic components with optimal clarity. It is concluded that (1) M-mode and 2-D echocardiography is useful in assessing Ionescu-Shiley valve function, (2) in vitro valve tears or detachment produces characteristic cusp fluttering, (3) careful attention to transducer positions is necessary to record high-quality valve images, and (4) these findings represent a data base for the longitudinal follow-up study of patients with the Ionescu-Shiley valve.