Hemodynamic evaluation of normally functioning sulzer carbomedics prosthetic valves

Keser, Nurgül; Nanda, Navin C.; Miller, Andrew P.; Vörös, Szilárd; Soydaş, Cahide; Agrawal, Gopal; Liguori, Chiara; Naftel, David C.; Pacifico, Albert D.; Kirklin, James K.; McGiffin, David C.; Holman, William L.

doi:10.1016/s0301-5629(02)00777-9

Cited by 12 publications

(6 citation statements)

References 30 publications

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“…In the present study, the two valve types were included because the purpose of the study was to examine the population of patients with mechanical valve replacement. Some differences between the two valve types were observed; however, caution must be exerted because the valve specifications were those given by different groups of investigators (5)(6)(7) and the comparison of the two valve types was beyond the scope of the present study. We designed the study retrospectively to maximize the number of patients in the study as well as to have a long follow-up time, allowing observation of the effect of mitral PPM on long-term follow-up.…”

Section: Limitationsmentioning

confidence: 86%

Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status

Bouchard

Eynden

Demers

et al. 2010

Canadian Journal of Cardiology

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Section: Limitationsmentioning

confidence: 86%

Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status

Bouchard

Eynden

Demers

et al. 2010

Canadian Journal of Cardiology

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“…For a PV in the mitral position, peak E velocity ≥1.9 m/sec and a ratio of the VTI pmv /VTI lvot ≥2.2 suggest valve dysfunction, either stenosis or regurgitation, and a pressure half time of >130 ms with a mean gradient ≥6 mmHg favor stenosis 5 . However, mechanical PV gradients do not consistently correlate with valve malfunction 6–9 . This may be in part due to high output states, patient prosthesis mismatch, the pressure recovery phenomenon, the complex flow velocities that occur in and around the PV, and the known fact that Doppler velocities are flow dependent 10,11 .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in Evaluation of Prosthetic Valve Function

et al. 2009

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We studied 31 patients with prosthetic valves (PVs) using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides an incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE both leaflets of the St. Jude mechanical PV can be visualized simultaneously, thereby increasing the diagnostic confidence in excluding valvular abnormalities and overcoming the well-known limitations of 2DTTE in the examination of PVs, which heavily relies on Doppler. Three-dimensional transthorathic echocardiography provides a more comprehensive evaluation of PV regurgitation than 2DTTE with its ability to more precisely quantify PV regurgitation, in determining the mechanism causing regurgitation, and in localizing the regurgitant defect. Furthermore, 3DTTE is superior in identifying, quantifying, and localizing PV thrombi and vegetations, in addition to the unique feature of providing a look inside mass lesions by serial sectioning. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of PVs and that it provides incremental knowledge to the echocardiographer.

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“…9 In a recent study, no correlation was found between pressure gradients and the true size of normally functioning Sulzer Carbomedics prosthetic valves. 10 Quantitative indices of valve function that are less dependent on flow include effective orifice area and Doppler velocity index. 1,5 Effective orifice area calculated with the continuity equation also demonstrates a wide range of reported normal values depending mainly on specific valve type and size.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is still useful to measure the effective orifice area since a value in the normal or nonstenotic range points to an unobstructed prosthesis, while a value in the stenotic range could mean either a normally functioning or an obstructed prosthesis and, therefore, may need further investigation. 10 Doppler velocity index is the ratio of blood velocity in the left ventricular outflow tract to that across the prosthesis. This index is dimensionless and has the advantage of being much less dependent on valve size.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls Leading to Misdiagnosis of a Normally Functioning Prosthetic Aortic Valve as Stenotic

Barbetseas¹,

Brili²,

Stamatopoulos³

et al. 2007

Echocardiography

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prosthetic aortic valve, pitfallsTransthoracic echocardiography is a useful tool for the evaluation of aortic prosthetic valve function, since the problems of acoustic shadowing and reverberations are less prominent compared with evaluation of mitral prosthetic valves. 1 However, the echocardiographer should be alert to identify potential pitfalls, which may lead to erroneous interpretation of recorded data. In this paper, we present two cases of erroneous diagnosis of obstruction of aortic mechanical valves. Case 1A 57-year-old woman with a 19 mm Advancing The Standard (ATS) bileaflet mechanical valve in the aortic position and a 25 mm ATS in the mitral position presented with heart failure symptoms during the last 5 months. The prostheses were implanted 2 years ago because of infective endocarditis of a previous mechanical aortic valve and of the native mitral valve. A transthoracic echocardiographic study performed in another laboratory diagnosed stenosis of the aortic prosthetic valve with a peak transvalvular gradient of 95 mmHg. The patient was then referred to our laboratory for further evaluation.The patient's blood pressure was 105 over 75 mmHg and her heart rate was 90 beats per minute. Physical examination revealed a harsh grade 3/6 holosystolic murmur heard best at the left sternal border in the 4th intercostal space, as well as rales at both lung bases. The electrocardiogram showed left bundle branch block Address for correspondence and reprint requests: Stamand the chest x-ray revealed cardiomegaly and interstitial edema with Kerley B lines.Transthoracic echocardiography showed mild dilation of the left ventricle relatively to the patient's body size (end-diastolic diameter 51 mm, end-systolic diameter 31 mm) with increased wall thickness (interventricular septum 14 mm, posterior wall 13 mm) and normal contractility, moderate dilation of the left atrium (50 mm) and severe pulmonary hypertension (pulmonary artery systolic pressure of approximately 90 mmHg) with dilation of the right heart chambers and moderate tricuspid regurgitation. The transmitral E-wave velocity was 2.5 m/sec, the mean pressure gradient was 11 mmHg, the peak gradient was 25 mmHg and the pressure half time was <120 msec (Fig. 1). These values suggested severe regurgitation of the prosthetic mitral valve. 1,2 Continuous wave Doppler at the left ventricular outflow tract revealed two superimposed velocity jets, a lower one with triangular shape, maximum velocity of 3.4 m/sec, mean pressure gradient of 30 mmHg and peak gradient of 45 mmHg, and a higher one with maximum velocity of 4.7 m/sec, which fell rapidly in mid-to late systole, mean pressure gradient of 57 mmHg and peak gradient of 88 mmHg (Fig. 2). Color flow imaging from the transesophageal approach documented severe paravalvular mitral regurgitation at the medial aspect of the sewing ring, with generation of a jet directed almost parallel to the left ventricular outflow tract (Fig. 3).

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Hemodynamic evaluation of normally functioning sulzer carbomedics prosthetic valves

Cited by 12 publications

References 30 publications

Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status

Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in Evaluation of Prosthetic Valve Function

Pitfalls Leading to Misdiagnosis of a Normally Functioning Prosthetic Aortic Valve as Stenotic

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