SHA24/021004

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 