Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound

“…138,139 In normally functioning bileaflet mechanical valves, the peak velocity is usually <1.9 m/s but can be up to 2.4 m/s. 135,139,140 As a general rule, however, a peak velocity <1.9 m/s is likely to be normal in most patients with mechanical valves unless there is markedly depressed LV function. If the peak velocity is $1.9 m/s in a mechanical valve, one should consider a normally functioning valve with a high velocity versus prosthetic valve dysfunction (stenosis or regurgitation).…”

“…The peak E velocity is easy to measure and provides a simple screen for prosthetic valve dysfunction. 135 The peak velocity can be elevated in hyperdynamic states, tachycardia, small valve size, stenosis, or regurgitation. Tachycardia exerts a particularly important effect on velocity and gradient measurements in the mitral position because of the associated shortening of the diastolic filling period.…”

“…If the peak velocity is $1.9 m/s in a mechanical valve, one should consider a normally functioning valve with a high velocity versus prosthetic valve dysfunction (stenosis or regurgitation). 135,139,140 This cutoff may be slightly higher in some bioprosthetic valves. If leaflet excursion is seen to be normal, there is no vegetation or thrombus, and there is no MR, it is likely the former.…”

Prosthetic Heart Valves

“…This parameter can therefore be helpful to screen for valve obstruction, particularly when the cross-sectional area of the LVOT cannot be obtained. 59 …”

“…27,59 Hence, a high gradient can be due to an associated subvalvular obstruction or a high-flow state (eg, hyperadrenergism, valvular regurgitation); such occurrences can be suspected when the DVI is normal (Ͼ0.35 for aortic or Ͼ0.45 for mitral prostheses). Conversely, the combination of a high gradient and a low DVI suggests valvular obstruction.…”