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Bart in Georgia said:
Update: We met with the surgeon today. He couldn't see the leak on the Echo, however, he could hear it when he listened to Bart's heart. He has scheduled a TEE for Thursday morning...we are hoping the result is a minor leak. Surgeon is speculating that calcification of the heart (Bart had four bouts of rheumatic fever when he was younger) has caused a suture to break.
It would be difficult to impossible to hear a perivalvular leak when it wasn't plainly evident on an Thor. Echo. Sutures that new would never break. They have tremendous strenght. They can come untied(extremely
rare) but commonly they tear loose from the surrounding heart tissue for mostly
two reasons: improper depth placement of the needle(doesn't go in deep enough to the heart) or the heart tissue is some how compromised and weakened. Sometimes when not enough sutures are use, this can cause
a leak, but again this is rare because manufacter states how many should be use and woe to the surgeons who would use less. Most paravalvular leaks
are not hemodynamically significant and some may seal with time.
Check the techinical quality level, unless it is good, an echo cannot
be depended upon to confirm a PV leak. It may be just a shadow. Most
PV leaks are watched, but do not need immediate attention, especially
if the rest of the echo stats remind in the normal range.
