Hemodynamic evaluation of patients with double-valve prostheses

Prompted by the sparse literature on and difficulties in evaluation of post-operative valve patients, we reviewed data from 27 double-valve cases having left ventricular catheterization. All were symptomatic in spite of mechanical prostheses in both mitral and aortic positions, with surgery 42 +/- 30 months previously. Transapical left ventricular entry was performed in 24 patients, retrograde in three; six had significant complications without permanent residua. Seventeen of 25 (68%) had elevated resting pulmonary wedge pressures with mitral prosthesis gradients 0 to 24 mm Hg and calculated valve areas 0.3 - greater than 3.0 cm2; aortic gradients were 0 to 42 mm Hg, areas 0.9 - greater than 3.0 cm2. Reoperation was done in eight patients and nine others had isolated left ventricular dysfunction. Calculated mitral areas as low as 0.7 cm2 and aortic 1.1 cm2 were associated with no apparent stenosis at surgery, and one patient had a pre-operative misdiagnosis of mitra prosthesis insufficiency. Hemodynamic evaluation of symptomatic double-prosthesis patients is difficult, often risky, and requires precise invasive measurements together with knowledge of the valve size. Prosthesis malfunction incorporates different disease processes than with native valves; the margin between abnormal parameters requiring reoperation and acceptable values may be narrow.