To the Editor: The image by Catapano et al1 gives misleading information concerning bubbles in the heart in patients with prosthetic valves. They speculated that “bright particles” seen in the left ventricular cavity are consistent with gas bubbles that occur in scuba divers after hypobaric decompression. We disagree with this speculation, because this phenomenon is well documented in patients ...

BACKGROUND AND PURPOSE The underlying embolic material detected by transcranial Doppler ultrasound in patients with prosthetic heart valves remains unknown. We undertook this study to evaluate the relation between the number of Doppler emboli signals and the activity of the coagulation system. METHODS Patients with various types of prosthetic valves (n = 120) and patients in atrial fibrillati...

Implantation of prosthetic valve requires consideration for anticoagulation. The current guideline recommends warfarin on all mechanical valves. Dabigatran is the new generation anticoagulation medication which is taken orally and does not require frequent monitoring. This drug is approved for treatment for atrial fibrillation and venous thromboembolism, but the latest large trial showed that t...

The evaluation of prosthetic valves can provide a unique challenge, and a thoughtful approach is required. High output states like anemia should be kept in the differential when evaluating elevated gradients across prosthetic valves. We present the case of a 69-year-old man with a Starr-Edwards prosthetic aortic valve who presented with symptoms of congestive heart failure and high transvalvula...

For patients with stenotic native valves, the modified Bernoulli equation (AIP = 4v2) may be applied to Doppler-measured transvalvular velocities to yield an accurate estimate of transvalvular gradients. Although it would be useful if the same approach could be used for those with stenotic prosthetic valves, no previous study has validated the Doppler technique in this setting. We therefore rec...