THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[15-08-2025 12.50] PPM 1: An independence day gift from our CBBLE team working onsite offline on a holiday! @PPM3👇
Microbubbles are commonly observed in patients with mechanical mitral prostheses but are rare in those with tissue valve prostheses. Two main mechanisms, cavitation and degassing, are thought to underlie their formation. Cavitation occurs during valve closure due to high transient pressure drops, generating bubbles that collapse quickly. Degassing, linked to CO 2 release, produces longer-lasting bubbles. Microbubbles can be visualized using two-dimensional, transoesophageal echocardiography, and advanced three-dimensional echocardiography, which can help pinpoint their origin, often from the valve closure interface. These bubbles are typically benign and do not indicate valve dysfunction but may lead to misdiagnosis as thrombus or vegetation.
[15-08-2025 13:56] PPM 5: Yes sir
We do see microbubbles in post mechanical prosthetic valve patients. They are more common in mitral prosthetic valve than aortic
High pressure gradient and closure force in mitral valve - as aortic valve closes during ventricular diastole when the gradients across are lower and mitral valve closes during systole when there are high gradients
The mitral valve orifice is larger and has slower blood flow velocities compared to the aortic valve.
Slower flow through the mitral position might predispose to bubble formation due to longer residence time of blood in low-pressure zones during closure.
[15-08-2025 13:57] PPM 5: So yes we do see these microbubbles in prosthetic valve patients. More often in mitral mechanical prosthesis
[15-08-2025 14:02] PM 5: Some other interesting features on how to differentiate a mechanical and bioprothesis valves on echo are the acoustic shadowing and reverberations which are seen in mechanical prosthesis
[15-08-2025 14:05] PPM 5: And also the prosthetic valve clicks on Doppler seen in mechanical valves.
[17-08-2025 09:59] PPM 1: Was just seeing this: https://youtu.be/wobauWEIEWU?feature=shared
[17-08-2025 09:59] PPM 7: It’s good 👌
[18-08-2025 14.23] PPM 4: Based on the discussion in the NKP CBBLE group regarding microbubbles in prosthetic heart valves, here's a concise synthesis of key insights and clinical implications:
### Key Points from the Discussion:
1. *Microbubble Phenomenon*:
- Primarily observed in *mechanical mitral valves* (rare in tissue valves).
- *Mechanisms*:
- Cavitation: Transient pressure drops during valve closure create short-lived bubbles.
- Degassing: CO₂ release forms longer-lasting bubbles.
- More common in mitral vs. aortic prostheses due to:
- Higher pressure gradients during systole (mitral closure).
- Larger orifice size and slower flow velocity, increasing bubble residence time.
2. *Echocardiographic Features*:
- *Detection: Best visualized via **transoesophageal echocardiography (TEE)*, especially with 3D imaging to pinpoint origin (e.g., valve closure interface).
- *Differentiation from Pathology*:
- Benign microbubbles vs. thrombus/vegetation: Microbubbles are typically transient, lack associated valve dysfunction, and don't cause clinical symptoms.
- Mechanical valves also show *acoustic shadowing, **reverberations, and characteristic **Doppler clicks* (absent in bioprostheses).
3. *Clinical Significance*:
- *Misdiagnosis Risk*: Microbubbles may mimic thrombus or infection, potentially leading to unnecessary interventions (e.g., anticoagulation escalation or reoperation).
- *Reassurance*: When classic microbubble features are present (e.g., brief appearance post-closure, no flow obstruction), they can be considered normal.
### Supporting Evidence:
- The shared [ResearchGate article](https://www.researchgate.net/publication/393061154_Illuminating_spontaneous_microbubbles_in_prosthetic_heart_valves_with_echocardiography_A_case_report_and_literature_review) corroborates these mechanisms and emphasizes cavitation/degassing as key drivers.
- The YouTube video likely demonstrates real-time microbubble dynamics in a prosthetic mitral valve (unreviewed due to link constraints).
### Recommendations:
- *For Imaging Specialists*: Use advanced TEE/3D echo to trace bubble origin and rule out pathology.
- *Clinical Workup*: If microbubbles are seen:
- Assess valve function (gradients, regurgitation).
- Correlate with symptoms—isolated microbubbles require no action.
- Differentiate from abnormal findings (e.g., thrombus shows persistent mass, abnormal motion).
- *Education*: Include microbubbles in echo training to avoid overdiagnosis.
This aligns with literature (e.g., [Khand et al.](https://www.researchgate.net/publication/393061154)) and reinforces that microbubbles are usually incidental. Kudos to the Narketpally team for the illustrative case! 🩺✨
(Note: YouTube video not accessed; summary based on text descriptions.)
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