Echocardiographic assessment of prosthetic mitral valves in children

Abstract

To assess PMV function in children, Doppler-derived hemodynamic parameters should be compared with their predictive values based on relative PMV sizes. The deviation of the VTI ratio and iEOA from their predictive values may indicate prosthetic obstruction.

Echocardiographic examination of mitral valve abnormalities in the paediatric population: current practices

“…In addition, paediatric recommendations must account for the effects of age, particularly in terms of the faster heart rates, and poor patient cooperation in neonates and infants. 52 These issues will have technical implications, including the settings used during the echocardiographic examination. Any evaluation must also address the presence of associated defects as they may influence management approaches.…”

“…Furthermore, mitral valve inflow flow velocities are dependent on the diastolic filling period and can be augmented by faster heart rates in infants and children (particularly in the neonatal age) 44 that remain a major issue. 6,10 Recently, z scores for prosthetic mitral valve have been proposed 52 for various indexes including peak E velocity (m/s), mean pressure gradient, velocity time integral ratio of prosthetic mitral valve inflow to left ventricular out flow body surface area-indexed effective orifice area (cm 2 /m 2 ), and pressure half time. However, these z scores have been built by using a very small sample size (e.g.…”

“…24 examinations performed at various times in 12 children (age 6.6-18.1 years)). 52 Measurements of the annulus are quite reproducible by two-dimensional echocardiography and robust nomograms are available. 53 In contrast, mitral valve area can be assessed by twodimensional echocardiography; however, validation with invasive catheterisation measurements has shown contrasting results 10,24 and nomograms are limited.…”

Technically successful fetal aortic valvuloplasty acutely improves left heart output

“…Prior studies have used MV VTI in the assessment of prosthetic MV function in adults as well as in children. 2,3 The aim of our study was to evaluate if LCO increases after FAV and to evaluate if LCO is predictive of postnatal circulation after FAV.…”

“…Velocity time integral (VTI) of semilunar valves is routinely used to estimate cardiac output, including in the fetus, and the same Doppler principles apply to MV flow. Prior studies have used MV VTI in the assessment of prosthetic MV function in adults as well as in children 2,3 . The aim of our study was to evaluate if LCO increases after FAV and to evaluate if LCO is predictive of postnatal circulation after FAV.…”