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Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography
Insights
Doppler echocardiography effectively detects prosthetic valve issues. The St. Jude valve shows optimal hemodynamics, with mild regurgitation detectable in various prosthetic valves using this method.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
Background:
- Prosthetic heart valves are crucial for patients with valvular heart disease.
- Assessing the hemodynamic performance and detecting malfunction of prosthetic valves is essential for patient management.
Purpose of the Study:
- To evaluate the hemodynamic performance of different prosthetic valves using Doppler echocardiography.
- To assess the utility of Doppler echocardiography in detecting prosthetic valve malfunction.
Main Methods:
- Doppler echocardiography was performed on 136 patients with normally functioning prosthetic valves (aortic, mitral, tricuspid).
- Various prosthetic valve types were studied, including St. Jude, Björk-Shiley, Beall, Starr-Edwards, and tissue valves.
- Peak and mean pressure gradients were measured; prosthetic valve orifice was calculated for mitral valves.
Main Results:
- The St. Jude valve demonstrated superior hemodynamics in the aortic position, with lower peak velocity and gradients compared to other valves.
- In the mitral position, the St. Jude valve exhibited the largest orifice area.
- Doppler echocardiography accurately identified complications in 15 out of 17 patients with malfunctioning prostheses.
Conclusions:
- The St. Jude valve exhibits the most optimal hemodynamic characteristics among the studied prostheses.
- Doppler echocardiography is a valuable tool for detecting prosthetic valve malfunction, particularly for St. Jude, Björk-Shiley, and tissue valves.
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.