SHA24/021004

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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 






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