Journal of the American Society of Echocardiography
Original articleDoppler Echocardiography of 79 Normal CarboMedics Mitral Prostheses: A Comprehensive Assessment Including Time-Velocity Integral Ratio and Prosthesis Performance Index
Section snippets
Patient Selection
From the cardiac surgical database at Mayo Clinic in Rochester, Minnesota, 81 patients aged 18 years or older were identified who underwent isolated mitral valve replacement with a CM prosthesis between 1993 and 2003 and who had a two-dimensional (2D) and Doppler echocardiographic study within 4 weeks after surgery. Included in the 81 patients were 13 with corrected transposition who had replacement of the left-sided, morphologic tricuspid valve, which is equivalent (from a hemodynamic
Baseline Clinical Characteristics
Patient characteristics are listed in Table 1. A standard bileaflet CM prosthesis was implanted in all patients. The indications for mitral valve replacement were mitral regurgitation in 47 patients (59%), mitral stenosis in 15 patients (19%), and mixed stenosis and regurgitation in 17 patients (22%). Seventy patients (89%) had TTE performed within the first week after mitral valve replacement. Results of physical examination and the appearance of the prosthesis by intraoperative
Discussion
In the present study of normal CM prostheses in the mitral position, all but three patients (4%) had either an E velocity that did not exceed 2 m/s or a TVIMVP/TVILVOT ratio less than 2.2, regardless of prosthesis size or left ventricular systolic function. PHT was less than 130 msec in all patients in whom it could be measured. The combination of an E velocity less than 1.9 m/s, a TVIMVP/TVILVOT ratio less than 2.2, and a PHT less than 130 msec was observed in 67% of our patients with complete
Conclusion
Ascertaining normal cardiac prosthetic valve function remains a challenge. The intent of this study was to provide in vivo data on a large number of normal CM mitral prostheses including all of the important Doppler variables described to date. The findings can be used for comparison when assessing patients with CM mitral prostheses. Outlier Doppler data should prompt further evaluation, including TEE, for possible prosthesis dysfunction.
Acknowledgment
Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.
References (11)
- et al.
Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function
Am J Cardiol
(2002) - et al.
Doppler echocardiography of 119 normal-functioning St Jude Medical mitral valve prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index
J Am Soc Echocardiogr
(2005) - et al.
Doppler echocardiography of normal Starr-Edwards mitral prostheses: a comprehensive function assessment including continuity equation and time-velocity integral ratio
J Am Soc Echocardiogr
(2005) - et al.
Echocardiographic description of the CarboMedics bileaflet prosthetic heart valve
J Am Coll Cardiol
(1993) - et al.
Doppler-echocardiographic assessment of CarboMedics prosthetic valves in the mitral position
J Am Soc Echocardiogr
(1994)
Cited by (13)
Doppler Parameters Derived from Transthoracic Echocardiography Accurately Detect Bioprosthetic Mitral Valve Dysfunction
2017, Journal of the American Society of EchocardiographyEchocardiographic Assessment of Prosthetic Heart Valves
2014, Progress in Cardiovascular DiseasesCitation Excerpt :E velocity and TVI ratio cut-off values predictive of bioprosthetic mitral valve regurgitation have not yet been validated. On the basis of a series from our institution, we propose that pathologic regurgitation is present when PHT < 120 ms and TVI ratio ≥ 2.6, ≥ 2.8 and ≥ 3.9 for mitral bileaflet mechanical, pericardial and porcine prostheses, respectively.5,6,14–16 If regurgitant jets are able to be adequately visualized, transprosthetic and periprosthetic mitral valve regurgitation can be semi-quantitated using the same methods that have been elucidated for native mitral valve regurgitation13 (Table 4).
Comprehensive hemodynamic assessment of 368 normal St. Jude Medical mechanical mitral valve prostheses based on early postimplantation echocardiographic studies
2013, Journal of the American Society of EchocardiographyComprehensive hemodynamic assessment of 305 normal carbomedics mitral valve prostheses based on early postimplantation echocardiographic studies
2012, Journal of the American Society of EchocardiographyCitation Excerpt :The recent ASE and EAE guidelines use the cutoff values determined by Fernandes et al.2 to define normal prosthetic mitral valve function. We used similar cutoff values when evaluating the 79 normal CM mechanical mitral valve prostheses included in our previous study6 and found that although 65 of the 70 patients (93%) for whom complete hemodynamic data were available had either E velocities < 1.9 m/sec or TVI ratios < 2.2; only 59 (84%) had E velocities < 1.9 m/sec, TVI ratios < 2.2, and PHTs < 130 msec. In the present study, only 160 of the 288 patients (56%) in whom PHT could be measured met these criteria.
Comprehensive echocardiographic assessment of mechanical tricuspid valve prostheses based on early post-implantation echocardiographic studies
2011, Journal of the American Society of EchocardiographyComprehensive echocardiographic assessment of the hemodynamic parameters of 285 tricuspid valve bioprostheses early after implantation
2010, Journal of the American Society of EchocardiographyCitation Excerpt :With significant mitral prosthetic and/or periprosthetic regurgitation, increased MG and TVIMVP are accompanied by normal to reduced stroke volume through the left ventricular outflow tract, resulting in an increased TVIMVP/TVILVOT. Nearly all patients with normal functioning bileaflet mechanical mitral valve prostheses have TVIMVP/TVILVOT < 2.2, and the combination of E velocity < 1.9 m/sec, TVIMVP/TVILVOT < 2.2, and PHT < 130 msec has been found to be highly predictive of normal mechanical mitral valve prosthesis function.3,9–11 On the other hand, the combination of E velocity ≥ 1.9 m/sec, TVIMVP/TVILVOT ≥ 2.2, and PHT < 130 msec suggests significant prosthetic and/or periprosthetic regurgitation for mechanical mitral valve prostheses.