[Pulsed Doppler echocardiography in prosthetic aortic and mitral valve replacement]

In 94 subjects with normally functioning heart valve prostheses (51 aortic and 43 mitral valve prostheses) and in 35 patients with intact aortic and mitral valves, blood flow velocity within the heart and the aortic root have been recorded using pulsed Doppler velocity studies in patients with diseased valves of the left heart. In addition, a further 7 patients were investigated using invasive catheter tip velocitometry, pre- and postoperatively. The preversus postoperative changes of maximum velocity and acceleration is characterized as follows: postoperative flow velocity tracings show approximately normal profiles comparable to normal valve function. Turbulence formation is diminished and the steep uptroke of the normal flow pattern is restituted. Differences in transprosthetic blood flow patterns dependent on the implanted prosthesis model can be defined. Bioprostheses, in particular the Carpentier-Edwards device, reliably approximate normal amplitude-time characteristics. This is also true for the St. Jude Medical prosthesis with central flow properties. Velocitometric signs of valve dysfunction were detected in 9 patients: sensitivity was 100%; specificity ranged from 76% in aortic to 96% in mitral prostheses. Pulsed Doppler echocardiography therefore is a useful complement in the non-invasive haemodynamic tools and can be repeatedly applied to a patient with prosthetic cardiac valve replacement.