Summary
To detect borderline mitral valve dysfunction in asymptomatic patients, with Björk-Shiley valves, we studied the patients' hemodynamics at rest and during exercise by Doppler echocardiography. Supine bicycle exercise was performed by 65 patients. The patients were divided into two groups according to the measurements of the exercise Doppler echocardiography: a normally functioning group (n = 45) and a borderline group (n = 20). The valve area at rest was 2.0 ± 0.6, 2.1 ± 0.7, and 2.3 ± 0.5cm2 with valve sizes of 25, 27, and 29 mm, respectively, in the normal group and 1.9 ± 0.5, 1.9 ± 0.4, and 2.1 ± 0.3 cm2 in the borderline group. The mitral valve area did not significantly change with exercise in either group. In the normal group, peak gradients increased from 9.9 ± 3.5, 9.7 ± 1.1, and 9.5 ± 1.6 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 15.1 ± 3.1, 14.0 ± 3.3, and 14.8 ± 2.6 mmHg with exercise. Mean gradients increased from 5.2 ± 1.2, 5.9 ± 1.3, and 5.8 ± 1.8 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 8.0 ± 2.5, 9.1 ± 2.0, and 8.8 ± 1.6 mmHg with exercise. In the borderline group, peak gradients increased from 10.5 ± 3.1, 10.1 ± 2.1, and 10.8 ± 1.7 mmHg with valve sizes of 25, 27, and 29 mm, respectively, at rest to 24.5 ± 4.2, 23.6 ± 4.4, and 22.4 ± 3.2 mmHg with exercise. The mean gradients increased from 5.8 ± 1.8, 6.0 ± 1.9, and 6.1 ± 1.6 mmHg, at rest to 13.4 ± 2.8, 13.4 ± 2.3, and 12.5 ± 2.2 mmHg after exercise. The increase in both peak and mean gradients with exercise (exercise — resting gradient) in the borderline group (more than 10 mmHg and more than 5 mmHg, respectively) was significantly higher than that in the normal group. Four of the 65 patients underwent reoperation for valve dysfunction due to pannus formation. All 4 of these patients were in the borderline group. Hemodynamic characteristics in the borderline stenotic patients were revealed by exercise. Exercise Doppler echocardiographic measurements can predict a concealed “pathologic” prosthetic valve stenosis in asymptomatic patients.
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Wilkins GT, Gillam LD, Kritzer GL, Levine RA, Palacios IF, Weyman AE (1986) Validation of continuous wave Doppler echocardiographic measurements of mitral and tricuspid prosthetic valve gradients: A simultaneous Doppler-catheter study. Circulation 74:786–795
Burstow DJ, Nishimura RA, Bailey KR, Reeder GS, Holmes DR, Seward JB, Tajik AJ (1989) Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients: A simultaneous Doppler-catheter correlative study. Circulation 80:504–514
Baumgartner H, Khan S, DeRobertis M, Czer L, Maurer G (1992) 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 19:324–332
Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7–11
Karliner JS, Gault JH, Eckberg DL, Mullins CB, Ross J Jr (1971) Mean velocity of fiber shortening: A simplified measure of left ventricular myocardial contractility. Circulation 44:323–333
Holen J, Simonsen S, Froysaker T (1979) An ultrasound Doppler technique for the noninvasive determination of the pressure gradient in the Björk-Shiley mitral valve. Circulation 59:436–442
Hatle L, Brubakk A, Tromsdal A, Angelsen B (1978) Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 40:131–140
Hatle L, Angelsen B (1982) Doppler ultrasound in cardiology. Lea and Febinger, Philadelphia, p 83
Panadis IP, Ross J, Mintz GS (1987) Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography. J Am Coll Cardiol 8:317–326
Alam M, Rosman HS, Lakier JB, Kemp S, Khaja F, Hautamaki K, Magilligan DJ, Stein PD (1987) Doppler and echocardiographic features of normal and dysfunctioning bioprosthetic valves. J Am Coll Cardiol 10:851–858
Reisner SA, Lichtenberg GS, Shapiro JR, Schwarz KQ, Meltzer RS (1989) Exercise Doppler echocardiography in patients with mitral prosthetic valves. Am Heart J 118:755–759
Leavitt JI, Coats MH, Falk RH (1991) Effects of exercise on transmitral gradient and pulmonary artery pressure in patients with mitral stenosis or a prosthetic mitral valve: A Doppler echocardiographic study. J Am Coll Cardiol 17:1520–1526
Reisner SA, Meltzer RS (1988) Normal values of prosthetic valve Doppler echocardiographic parameters: A review. J Am Soc Echocardiography 1:201–210
Björk VO, Book K, Holmgran A (1973) Significance of position and opening angle of the Björk-Shiley tilting disc valve in mitral surgery. Scand J Thorac Cardiovasc Surg 7:187–201
Planinc D, Jeric M, Mihatov S, Omcikus M, Pagon L, Rudar M (1991) Doppler evaluation of prosthetic mitral valves. Acta Cardiol 46:79–83
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Shigenobu, M., Sano, S. Detection of “pathologic” prosthetic valve stenosis via exercise Doppler echocardiography. Heart Vessels 10, 35–40 (1995). https://doi.org/10.1007/BF01745075
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DOI: https://doi.org/10.1007/BF01745075