Assessment of normal and abnormal prosthetic mitral valves by Doppler echocardiography
- 45 Downloads
Pulsed, continuous-wave, and color Doppler were performed in 165 normal mitral prostheses and 58 patients with prosthetic dysfunction (46 regurgitant and 12 obstructive valves) proved by catheterization and/or surgery. Mean mitral gradient (MG) and pressure half-time (PHT) were determined in all cases.
Among normal prostheses, a wide range of both MG and PHT was observed in each type of valve and a considerable overlap between valves of different size. St-Jude's valve had the most optimal hemodynamics. Mild mitral insufficiency was detected in 14% of tissue and 24% of mechanical mitral valves.
Repeat studies were performed in 30 patients over a 2.4 years period. Nine patients developed Doppler evidence of new prosthetic dysfunction, while Doppler parameters remained unchanged in 21 patients during the follow-up period.
Among malfunctioning valves, Doppler correctly identified all cases of prosthetic obstruction (n=12), and 42 of 46 regurgitant valves.
We conclude that Doppler echocardiography is a very useful technique in both non-invasive assessment and follow-up of normal prosthetic valves in the mitral position and in detecting prosthetic dysfunction, especially when prosthetic obstruction is present.
Key wordsdoppler echocardiography prosthetic mitral valves malfunctioning mitral prostheses follow-up of mitral prostheses
Unable to display preview. Download preview PDF.
- 1.Alam M, Lakier JB, Pichard SD, Goldstein S. Echocardiographic evaluation of porcine bioprosthetic valves: experience with 309 normal and 59 dysfunctioning valves. Am J Cardiol 1983; 52: 309–13.Google Scholar
- 2.Lesbre JP, Isorni C, Lesperance J, et al. Les dysfonctions de bioprothèses. Apport respectif de l'échocardiographie et du Doppler. Arch Mal Coeur 1986; 9: 1278–86.Google Scholar
- 3.Lesbre JP, Chassat C, Lesperance J, et al. Evaluation des nouvelles bioprothèses péricardiques par Doppler pulsé et continu. Arch Mal Coeur 1986; 10: 1439–48.Google Scholar
- 4.Mintz GS, Ross JJ, Panidis I, Chandrasekaran K. Doppler ultrasound in 366 patients with prosthetic valves: a 4 year experience. (abstract) Circulation 1988; 78 (suppl. II): II-606.Google Scholar
- 5.Gibbs JL, Wharton GA, Williams GJ. Doppler ultrasound of normally functioning mechanical mitral and aortic valve prostheses. Int J Cardiol 1988; 18: 391–8.Google Scholar
- 6.Simpson IA, Reece IJ, Houston AB, Hutton I, Wheatly DJ, Cobbe SM. Non-invasive assessment by Doppler ultrasound of 155 patients with bioprosthetic valves: a comparison of the Wessex porcine, low profile Ionescu-Shiley, and Hancock pericardial bioprostheses. Br Heart J 1986; 56: 83–8.Google Scholar
- 7.Panidis IP, Ross J, Mintz GS. Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography. J Am Coll Cardiol 1986; 8: 317–26.Google Scholar
- 8.Sagar KB, Wann S, Paulsen WHJ. Romhilt DW. Doppler echocardiographic evaluation of Hancock and Bjork-Shiley prosthetic valves. J Am Coll Cardiol 1986; 7: 681–7.Google Scholar
- 9.Alam M, Rosman HS, Lakier JB, et al. Doppler and echocardiographic features of normal and dysfunctioning bioprosthetic valves. J Am Coll Cardiol 1987; 10: 851–8.Google Scholar
- 10.Hatle L, Angelsen B. Pulsed and continuous wave Doppler in diagnosis and assessment of various heart lesions. In: Hatle L, Angelsen B. Doppler ultrasound in Cardiology. Physical principles and clinical applications, 2d, Lea and Febiger, Philadelphia, 1985: 117–9.Google Scholar
- 11.Abbasi AS, Allen MW, De Cristofaro D, Ungar I. Detection and estimation of the degree of mitral regurgitation by range-gated pulsed Doppler echocardiography Circulation 1980; 61: 143–7.Google Scholar
- 12.Miyatake KK, Izumi S, Okamoto M, et al. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol 1986; 7: 82–8.Google Scholar
- 13.Hatle L, Angelsen B. Doppler ultrasound in cardiology. Physical principles and clinical applications, 2nd, Lea and Febiger, Philadelphia, 1985: 178–87.Google Scholar
- 14.Sellers R, Levy M, Amplatz K, Lillemei C. Left retrograde cardio angiography in acquired cardiac disease. Technic, indications, interpretations in 700 cases. Am J Cardiol 1964; 14: 437–47.Google Scholar
- 15.Fawzy ME, Halim M, Ziady G, Mercer E, Phillips R, Andaya W. Hemodynamic evaluation of porcine bioprotheses in the mitral position by Doppler echocardiography. Am J Cardiol 1987; 59: 643–6.Google Scholar
- 16.Burstow DJ, Nishimura RA, Tajik AJ, Reeder GS, Hurley DV, Holmes DR. Correlation of Doppler-derived gradients across prosthetic valves with cardiac catheterization: A simultaneous Doppler-dual catheter study (abstract). Circulation 1988; 78 (suppl II): II-607.Google Scholar
- 17.Wilkins GT, Gillam LD, Kritzer GL, Levine RA, Palacios IF, Weyman AE. Validation of continuous-wave Doppler echocardiographic measurements of mitral and tricuspid prosthetic valve gradients: a simultaneous Doppler-catheter study. Circulation 1986; 74: 786–95.Google Scholar
- 18.Williams GA, Labovitz AJ. Doppler hemodynamic evaluation of prosthetic (Starr-Edwards and Bjork-Shiley) and bioprosthetic (Hancock and Carpentier-Edwards) cardiac valves. Am J Cardiol 1985; 56: 325–32.Google Scholar
- 19.Chaitman BR, Bonan R, Lepage G, et al. Hemodynamic evaluation of the Carpentier-Edwards porcine xenograft. Circulation 1979; 60: 1170–82.Google Scholar
- 20.Shukri FK, Folland ED, Sethi GK, et al. Six months post operative hemodynamics of the Hancock heterograft and the Bjork-Shiley prosthesis: results of a Veterans Administration Cooperative prospective randomized trial. J Am Coll Cardiol 1988; 12: 8–18.Google Scholar
- 21.Horstkotte D, Haerten K, Herzer JA, Seipel L, Bricks W, Loogen F. Preliminary results in mitral valve replacement with the St-Jude medical prosthesis: comparison with the Bjork-Shiley valve. Circulation 1981; 64 (suppl. II): 203–9.Google Scholar
- 22.Chambers J, McLoughlin N, Rapson A, Jackson G. Effects of changes in heart rate on pressure half-time in normally functioning mitral valve prostheses. Br Heart J 1988; 60: 502–6.Google Scholar
- 23.Moro E, Nicolosi GL, Zanuttini D, Cervesato E, Roelandt J. Indluence of aortic regurgitation on the assessment of the pressure half-time and derived mitral valve area in patients with mitral stenosis. Eur Heart J 1988; 9: 1010–7.Google Scholar
- 24.Karp KK, Teien D, Bjerle P, Eriksson P. Reassessment of valve area determinations in mitral stenosis by the pressure half-time method: impact of left ventricular stiffness and peak diastolic pressure difference. J Am Coll Cardiol 1989; 13: 594–9.Google Scholar
- 25.Olmstead SF, Pearlman AS, Janko CL. Identification of prosthetic mitral valve dysfunction: utility of Doppler parameters (abstract). Circulation 1986; 74 (suppl. II): II-390.Google Scholar
- 26.Sprecher DL, Adamick R, Adams D, Kisslo J. In vitro color flow, pulsed and continuous wave Doppler ultrasound masking of flow by prosthetic valves. J Am Coll Cardiol 1987; 9: 1306–10.Google Scholar
- 27.Taams MA, Cussenhoven EJ, Cahalan MK, et al. Transoesophageal Doppler color flow imaging in the detection of native and Bjork-Shiley mitral valve regurgitation. J Am Coll Cardiol 1989; 13: 95–9.Google Scholar