Prosthetic Valve Assessment
Dr. Saeed AL Ahmari Prince Sultan Cardiac Center
Types of Prostatic Valves
Mechanical
◦ Bileaflet ◦ Single tilting disc ◦ Caged-ball
Biological ◦ Stented
Porcine Xenograft Pericardial xenograft
◦ Stentless
Porcine xenograft Pericardial Xenograft Homograft(Autograft) Allograft
◦ Perctaneous (Edward Sabien, Core Valve )
Mechanical Prosthesis
Bioprosthesis
2- Echocardiography Valve structure Leaflet, or disc mobility Vegetation Thrombus Pannus Dehesence Degeneration
Starr- Edwards Prosthetic Valve ((Ball & Cage
Tilting Disc MV prosthesis
(Aortic Homograft (Allograft
TAVI
D Echocardiography-3
D Ecocardiography-3
D Echocardiography-3
Doppler Echocardiography Assessment Gradient (Peak, Mean ) Effective orifice Area Regurgitation: site, and severity
Built-In prosthesis leaks
Effective AV prosthesis area
Effective AV prosthesis area
Effective AV prosthesis area
(Doppler Velocity Index (DVI
Pressure Recovery
Correlation of Doppler, and cath derived gradients
Correlation between catheter and Doppler gradient
Reference for AV prosthetic gradient
Para-prosthetic regurgitation severity assessment of AV prosthesis
Grading Criteria for Paravalvular AR Circumference = 6″ AR = 0.1+0.35 = 0.45″ Ratio = 8% Severity = Mild (< 10%)
Circumference = 6″ AR = 0.5+0.5 = 1.0″ Ratio = 17% Severity = Moderate (10 – 20%) (Trans AR also present) Circumference = 6″ AR = 0.6+1.1 = 1.7″ Ratio = 28% Severity = Severe (> 20%)
Images courtesy of Pamela Douglas, MD, FASE
MV prosthesis Effective orifice area
MV prosthesis intrinsic Leak
MV prosthesis paravalvular leak
MV prosthesis ? leak
MV prosthesis pseudo leak
Para-prosthetic regurgitation assessment of mitral prosthesis
Complication of Prosthetic Valves
Primary valve failure ◦ Ball variance, disc embolization ◦ Biological valve degeneration
Thrombosis Thromboembolism: 1-4 % per pat per year Endocarditis: 0.5 % per year, 45-75 % mortality Patient prosthesis mismatch
Dehiscent MV mechanical prosthesis
Dehiscent MV mechanical prosthesis
AV prosthesis with pannus formation
MV prosthesis obstruction
AV bioprossthesis IE
AV bioprossthesis IE
MV prosthesis thrombosis
Obstructed TV prosthesis
TV mechanical Prosthesis obstruction
CT detection of prosthetic valve obstruction
AV Prosthesis Endocarditic
MV bioprosthesis endocarditis
AV bioprosthesis endocarditis
What is the complication
What is the complication
What is the complication
Conclusion Knowledge of Prosthetic valve types & hemodynamics Echo provide complete assessment of prosthetic valve structure and function Baseline Echo assessment is essential for future follow-up TEE is superior to TTE in assessing complication of prosthetic valves 3-D echo will be useful in assessing prosthetic valves