Normal and abnormal prosthetic valve function as assessed by doppler echocardiography

Abstract

Doppler echocardiography was performed in 136 patients with a normally functioning prosthetic valve in the aortic (n = 59), mitral (n = 74) and tricuspid (n = 3) positions. These included patients with St. Jude (n = 82), Björk-Shiley (n = 18), Beall (n = 13), Starr-Edwards (n = 7) or tissue (n = 16) valves. Peak and mean pressure gradients across the prostheses were measured using the simplified Bernoulli equation. The prosthetic valve orifice (PVO, in square centimeters), only in the mitral position, was calculated by the equation: PVO = 220/pressure half-time. In the aortic position, the St. Jude valve had a lower peak velocity (2.3 +/- 0.6 m/s, range 1.0 to 3.9), peak gradient (22 +/- 12 mm Hg, range 4 to 61) and mean gradient (12 +/- 7 mm Hg, range 2 to 32) than the other valves (p less than 0.05) when compared with Starr-Edwards). In the mitral position, the St. Jude valve had the largest orifice (3.0 +/- 0.6 cm2, range 1.8 to 5.0) (p less than 0.0001 compared with all other valves). Insignificant regurgitation was commonly found by pulsed mode Doppler technique in patients with a St. Jude or Björk-Shiley valve in the aortic or mitral position and in patients with a Starr-Edwards or tissue valve in the aortic position. In 17 other patients with a malfunctioning prosthesis (four St. Jude, two Björk-Shiley, four Beall and seven tissue valves) proven by cardiac catheterization, surgery or autopsy, Doppler echocardiography correctly identified the complication (significant regurgitation or obstruction) in all but 2 patients who had a Beall valve. It is concluded that 1) the St. Jude valve appears to have the most optimal hemodynamics; mild regurgitation can be detected by the Doppler technique in normally functioning St. Jude and Björk-Shiley valves in the aortic or mitral position and in Starr-Edwards and tissue valves in the aortic position, and 2) Doppler echocardiography is a useful method for the detection of prosthetic valve malfunction, especially when the St. Jude, Björk-Shiley and tissue valves are assessed.

Five-Year Follow-up After Heart Valve Replacement With the CarboMedics Bileaflet Prosthesis

“…These results presented earlier compare favorably with those of other mechanical valves of similar design [20,21]. When comparing patients with different valve sizes, peak velocity and pressure gradients are inversely related to annulus diameter.…”

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] It decreased to 5Ϯ3 mmHg (Pϭ. 000) soon after T and to 4Ϯ2 mmHg (Pϭ0.000 versus baseline, PϭNS versus end of T infusion) at 24 hours.…”

“…[17][18][19][20][21][22][23] Since the introduction of TEE, ultrasound imaging has become the most used test in case of prosthesis dysfunction. This change happened without convincing scientific evidence of the superiority of 1 technique over the other.…”

Maximal QRS Duration and Total Lead Amplitude as Markers of LVH in Paced ECGs, Correlated with Echocardiographically Derived LV Mass

“…This fact might account for the better correlation and diagnostic value in our study, since myo cardial infarctions tend to increase QRS duration with no increase in LV mass [15,16].…”