Assessment of trans‐aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses

Abstract

Accurate evaluation of trans-aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non-invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans-valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans-septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans-valvular gradients using a 0.014˝ diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76-year-old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high-fidelity 0.014˝ diameter coronary pressure guidewire resulted in the detection of a normal trans-valvular pressure gradient across the mechanical aortic valve. This avoided a high-risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc.

From minimally to maximally invasive; VT ablation in the setting of mechanical aortic and mitral valves

“…Consideration needs to be made when performing an apical puncture, either transcutaneously or via a mini‐thoracotomy. In the setting of tilting disc valves, advancement of guidewires and sheaths creates a risk of valve entrapment and acute regurgitation, which can be fatal 9 . In this case, the presence of a caged ball valve in the mitral position granted a suitable target for the guidewire, as acute entrapment of a caged ball valve is of negligible risk.…”

“…In the setting of tilting disc valves, advancement of guidewires and sheaths creates a risk of valve entrapment and acute regurgitation, which can be fatal. 9 In this case, the presence of a caged ball valve in the mitral position granted a suitable target for the guidewire, as acute entrapment of a caged ball valve is of negligible risk. In previous descriptions, the Cook needle was connected to pressure monitoring to determine when access to the LV cavity had been gained.…”

Acute Left Ventricular Ballooning: Tools to Differentiate Hypertrophic Cardiomyopathy with Outflow Obstruction from Neurohumoral Takotsubo Syndrome

“…This technique uses a single arterial access site and commonly available traditional catheters, is inexpensive, and demonstrates high fidelity when compared to pressure gradients measured by a dual lumen catheter [ 71 ]. A 6F guiding catheter in the aorta can also be paired with an fractional flow reserve, instantaneous wave-free ratio, diastolic hyperemia-free ratio, or relative full-cycle ratio (FFR, iFR, DFR, or RFR) wires in the LV for simultaneous pressure recordings [ 14 , 72 , 73 ].…”