Abstract
Stenosis of bioprosthetic or mechanical aortic valves can occur due to valve degeneration, pannus formation, thrombosis, and endocarditis. Prosthetic valve stenosis is characterized by elevated trans-aortic velocities and gradients; however, it is imperative to realize that the mere presence of an elevated gradient across an aortic valve prosthesis is not sufficient to diagnose prosthesis stenosis. This chapter will review the valve design and types, causes of prosthetic aortic valve stenosis, approach to evaluate patients with elevated trans-aortic prosthesis gradient, as well as the complimentary role of CT and MRI.
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References
Rahimtoola SH. Choice of prosthetic heart valve for adult patients. J Am Coll Cardiol. 2003;41:893–904.
Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.
Pibarot P, Demesnil JG. Valvular heart disease: changing concepts in disease management prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.
Eikelboom JW M.D., Connolly SJ M.D., Brueckmann M M.D., Granger CB M.D., Kappetein AP M.D., Ph.D., Mack MJ M.D., Blatchford J C.Stat., Devenny K B.Sc., Friedman J M.D., Guiver K M.Sc., Harper R Ph.D., Khder Y M.D., Lobmeyer MT Ph.D., Maas H Ph.D., Voigt J-U M.D., Simoons ML M.D., Van de Werf F M.D., Ph.D., RE-ALIGN Investigators. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206–14.
Rajani R, Mukherjee D, Chambers JB. Doppler echocardiography in normally functioning replacement aortic valves: a review of 129 studies. J Heart Valve Dis. 2007;16:519–35. 332.
Baumgartner H, Khan S, DeRobertis M, Czer L, Maurer G. Effect of prosthetic aortic valve design on the Doppler-catheter gradient correlation: an in vitro study of normal St. Jude, Medtronic-Hall, Starr-Edwards and Hancock valves. J Am Coll Cardiol. 1992;19(2):324.
Chafizadeh ER, Zoghbi WA. Doppler echocardiographic assessment of the St. Jude Medical prosthetic valve in the aortic position using the continuity equation. Circulation. 1991;83:213–23.
Rothbart RM, Castriz JL, Harding LV, Russo CD, Teague SM. Determination of aortic valve area by two-dimensional and Doppler echocardiography in patients with normal and stenotic bioprosthetic valves. J Am Coll Cardiol. 1990;15:817–24.
Zabalgoitia M, Herrera CJ, Chaudhry FA, Calhoon JH, Mehlman DJ, O’Rourke RA. Improvement in the diagnosis of bioprosthetic valve dysfunction by transesophageal echocardiography. J Heart Valve Dis. 1993;2:595–603.
Ben Zerky S, Saad RM, Little SH, Zoghbi WA. Flow acceleration time: a novel diagnostic parameter for prosthetic aortic valve stenosis [abstract]. Circulation. 2008;118:S1069.
Daneshvar SA, Rahimtoola SH. Valve prosthesis-patient mismatch (VP-PM). A long-term perspective. J Am Coll Cardiol. 2012;60:1123–35.
Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol. 2000;36:1131–41.
Pibarot P, Dumesnil JG. Valve prosthesis-patient mismatch, 1978 to 2011. From original concept to compelling evidence. J Am Coll Cardiol. 2012;60(13):1136–9.
Mohr-Kahaly S, Kupferwasser I, Erbel R, et al. Value and limitations of transesophageal echocardiography in the evaluation of aortic prostheses. J Am Soc Echocardiogr. 1992;6:12–20.
Muratori M, Montorsi P, Teruzzi G, et al. Feasibility and diagnostic accuracy of quantitative assessment of mechanical prostheses leaflet motion by transthoracic and transesophageal echocardiography in suspected prosthetic valve dysfunction. Am J Cardiol. 2006;97:94–100.
Habets J, Mali P, Budde RP. Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics. 2012;32(7):1893–905.
Tsai IC, Lin YK, Chang Y. Correctness of multidetector row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol. 2009;19(4):857–67.
Chenot F, Montant P, Goffinet C. Evaluation of anatomic valve opening and leaflet morphology in aortic valve bioprosthesis by using multidetector CT: comparison with transthoracic echocardiography. Radiology. 2010;255(2):377–85.
Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, et al. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis. Increased valvular 18F-Fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol. 2013;61:2374–82.
Millar BC, Prendergast BD, Alavi A, Moore JE. 18-FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. Int J Cardiol. 2013;167:1724–36.
Muratori M, Montorsi P, Maffessanti F, Teruzzi G, Zoghbi WA, et al. Dysfunction of bileaflet aortic prosthesis. Accuracy of Echocardiography versus fluoroscopy. J Am Coll Cardiol Img. 2013;6:196–205.
Ueda T, Teshima H, Fukunaga S, Aoyagi S, Tanaka H. Evaluation of prosthetic valve obstruction on electrocardiographically gated multidetector-row computed tomography. Identification of sub-prosthetic pannus in the aortic position. Circ J. 2013;77:418–23.
Abbas AE, Franey LM, Goldstein J, Lester S. Aortic valve stenosis: to the gradient and beyond – the mismatch between area and gradient severity. J Interv Cardiol. 2013;26:183–94.
Pham N, Zaitoun H, Mohammed TL, DeLaPena-Almaguer E, Martinez F, Novaro GM, Kirsch J. Complications of aortic valve surgery: manifestations at CT and MR imaging. Radiographics. 2012;32:1873–92.
Orban M, Sinnecker D, Mair H, Nabauer M, Kupatt C, Schmitz C, Massberg S, Laugwitz KL, Barthel P. Transcatheter aortic-valve endocarditis confirmed by transesophageal echocardiography. Circulation. 2013;127:e265–6.
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Gallagher, M.J. (2015). Prosthetic Aortic Valves and Diagnostic Challenges. In: Abbas, A. (eds) Aortic Stenosis. Springer, London. https://doi.org/10.1007/978-1-4471-5242-2_10
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DOI: https://doi.org/10.1007/978-1-4471-5242-2_10
Publisher Name: Springer, London
Print ISBN: 978-1-4471-5241-5
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