Accuracy of Doppler-echocardiographic parameters for the detection of aortic bileaflet mechanical prosthetic valve dysfunction

Smadi, Othman; García, Julio; Gaillard, Emmanuel; Hassan, Ibrahim; Kadem, Lyes

doi:10.1093/ehjci/jet059

Cited by 17 publications

(20 citation statements)

References 16 publications

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“…In light of this early work, our observation of a mechanical valve significantly reducing erratic aortic blood flow to resemble healthy volunteers is encouraging. Similar to previous reports [6,22], post-ARR transvalvular pressure gradients remained elevated compared with healthy volunteers. This may be due to our use of 'peak' as opposed to 'mean' velocity gradients.…”

Section: Discussionsupporting

confidence: 90%

Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit†

Keller

Malaisrie

Kruse

et al. 2016

Interactive CardioVascular and Thoracic Surgery

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Section: Discussionsupporting

confidence: 90%

Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit†

Keller

Malaisrie

Kruse

et al. 2016

Interactive CardioVascular and Thoracic Surgery

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“…The use of the difference between the actual EOA value and reference values (EOA‐D) as described in was also considered in this study. In the aortic position, this parameter provides the best accuracy in identifying valve dysfunction (BHMV‐DYS) for both in vitro and in vivo studies . However, in the mitral position, the values for EOA‐D showed significant overlapping for the St. Jude valve (Fig.…”

Section: Discussionmentioning

confidence: 97%

Are the Current Doppler Echocardiography Criteria Able to Discriminate Mitral Bileaflet Mechanical Heart Valve Malfunction? An In Vitro Study

et al. 2016

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Malfunction of bileaflet mechanical heart valves in the mitral position could either be due to patient-prosthesis mismatch (PPM) or leaflet obstruction. The aim of this article is to investigate the validity of current echocardiographic criteria used for diagnosis of mitral prosthesis malfunction, namely maximum velocity, mean transvalvular pressure gradient, effective orifice area, and Doppler velocity index. In vitro testing was performed on a double activation left heart duplicator. Both PPM and leaflet obstruction were investigated on a St. Jude Medical Master. PPM was studied by varying the St. Jude prosthesis size (21, 25, and 29 mm) and stroke volume (70 and 90 mL). Prosthesis leaflet obstruction was studied by partially or totally blocking the movement of one valve leaflet. Mitral flow conditions were altered in terms of E/A ratios (0.5, 1.0, and 1.5) to simulate physiologic panel of diastolic function. Maximum velocity, effective orifice area, and Doppler velocity index are shown to be insufficient to distinguish normal from malfunctioning St. Jude prostheses. Doppler velocity index and effective orifice area were 1.3 ± 0.49 and 1.83 ± 0.43 cm(2) for testing conditions with no malfunction below the 2.2 and 2 cm(2) thresholds (1.19 cm(2) for severe PPM and 1.23 cm(2) for fully blocked leaflet). The mean pressure gradient reached 5 mm Hg thresholds for several conditions of severe PPM only (6.9 mm Hg and mean maximum velocity value: 183.4 cm/s) whereas such value was never attained in the case of leaflet obstruction. In the case of leaflet obstruction, the maximum velocity averaged over the nine pulsed-wave Doppler locations increased by 38% for partial leaflet obstruction and 75% for a fully blocked leaflet when compared with normal conditions. Current echocardiographic criteria might be suboptimal for the detection of bileaflet mechanical heart valve malfunction. Further developments and investigations are required in order to further improve current guidelines.

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“…However, TTE, TEE and cineradiography sometimes fail to diagnose the causative mechanism of PVT, thrombus or pannus [8][9][10][11]. In prosthetic heart valve obstruction without thrombosis, leaflet restriction was absent in 17 % cases by fluoroscopy and mass detection was absent in 66 % cases by TEE [10].…”

Section: Discussionmentioning

confidence: 99%

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography

et al. 2015

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A 62-year-old female patient underwent mitral valve replacement with a 31/33-mm On-X valve for ischemic mitral valve regurgitation. Three months later, transthoracic echocardiography incidentally showed a blocked leaflet with 6 mmHg of mean pressure gradient and 2.4 cm(2) of mitral valve orifice area. Transesophageal echocardiography could not detect thrombus. Electrocardiographically gated multidetector-row computed tomography (MDCT) clearly demonstrated a blocked leaflet in the close position and thrombus (2 cm in length, 0.4 cm(2) in area) attached onto the atrial aspect of the leaflet. These findings observed by MDCT were confirmed at reoperation. MDCT was useful diagnostic method for visualizing prosthetic valve thrombosis.

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Accuracy of Doppler-echocardiographic parameters for the detection of aortic bileaflet mechanical prosthetic valve dysfunction

Cited by 17 publications

References 16 publications

Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit†

Reduction of aberrant aortic haemodynamics following aortic root replacement with a mechanical valved conduit†

Are the Current Doppler Echocardiography Criteria Able to Discriminate Mitral Bileaflet Mechanical Heart Valve Malfunction? An In Vitro Study

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography

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