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Echocardiographic Evaluation of Prosthetic Heart Valves

  • Echocardiography (JM Gardin, Section Editor)
  • Published:
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Abstract

The specific flow pattern and imaging features of prosthetic heart valves poses major challenges for the Doppler echocardiographic assessment of prosthetic valve structure and function. A comprehensive approach that integrates several semi-quantitative and quantitative parameters obtained from multiple views is key to appropriately detect and quantitate prosthetic valve dysfunction and complications. In patients with prosthetic valves, and particularly in those with mitral prostheses, transesophageal echocardiography is often required to confirm and/or complement information obtained by transthoracic echocardiography. Three-dimensional echocardiography may provide incremental information for the identification of the underlying etiology of prosthetic valve stenosis or regurgitation. Transcatheter aortic valve implantation has rapidly expanded in the past 10 years and paravalvular regurgitation is frequent following this procedure. Given that paravalvular regurgitant jets are often multiple, irregular, and eccentric, the grading of this type of regurgitation is particularly challenging and requires an integrative multiwindow, multiplane, multiparametric approach.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

CW:

Continuous wave

DVI:

Doppler velocity index

EOA:

Effective orifice area

LV:

Left ventricle/ventricular

LVEF:

Left ventricular ejection fraction

LVOT:

Left ventricular outflow tract

PW:

Pulse wave

PPM:

Prosthesis-patient mismatch

PVR:

Paravalvular regurgitation

SD:

Standard deviation

TAVI:

Transcatheter aortic valve implantation

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

VARC:

Valve Academic Research Consortium

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yacoub MH, Takkenberg JJ. Will heart valve tissue engineering change the world? Nat Clin Pract Cardiovasc Med. 2005;2:60–1.

    CAS  PubMed  Google Scholar 

  2. Fanning JP, Platts DG, Walters DL, Fraser JF. Transcatheter aortic valve implantation (TAVI): valve design and evolution. Int J Cardiol. 2013;168:1822–31.

    PubMed  Google Scholar 

  3. Zoghbi WA, Chambers JB, Dumesnil JG, 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. J Am Soc Echocardiogr. 2009;22:975–1014. quiz 1082–4. This article represents the most recent guidelines of the American Society of Echocardiography for the Doppler-echocardiographic assessment of prosthetic valves.

  4. Bach DS. Transesophageal echocardiographic (TEE) evaluation of prosthetic valves. Cardiol Clin. 2000;18:751–71.

    CAS  PubMed  Google Scholar 

  5. Gerstein NS, Copeland SG, Kratzert WB, Deriy L, Windsor J. Now you see it, now you don’t: 3D echocardiographic evaluation of a prosthetic aortic valve. J Cardiothorac Vasc Anesth. 2013;27:1060–3.

    PubMed  Google Scholar 

  6. Muratori M, Montorsi P, Maffessanti F, et al. Dysfunction of bileaflet aortic prosthesis: accuracy of echocardiography versus fluoroscopy. J Am Coll Cardiol Img. 2013;6:196–205. This study shows that the difference between measured EOA and normal reference EOA as well as the ratio of acceleration time to LV ejection time are the most useful Doppler-echocardiographic parameters to identify prosthetic valve stenosis.

    Google Scholar 

  7. Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.

    Article  PubMed  Google Scholar 

  8. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115:2856–64.

    Article  PubMed  Google Scholar 

  9. Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J. 2011;32:2189–214. This paper presents the recommendations of the European Association of Echocardiography and American Society of Echocardiography for the Doppler-echocardiographic assessment of transcatheter heart valves and devices.

    PubMed  Google Scholar 

  10. Evin M, Pibarot P, Guivier-Curien C, Tanne D, Kadem L, Rieu R. Localized transvalvular pressure gradients in mitral bileaflet mechanical heart valves and impact on gradient overestimation by Doppler. J Am Soc Echocardiogr. 2013;26:791–800. This in vitro study provides some new insights regarding the localization and magnitude of the localized high velocities within the central orifice of mitral bileaflet mechanical valves.

    PubMed  Google Scholar 

  11. Pibarot P, Dumesnil JG. Doppler echocardiographic evaluation of prosthetic valve function. Heart. 2012;98:69–78.

    Article  PubMed  Google Scholar 

  12. Smadi O, Garcia J, Pibarot P, Gaillard E, Hassan I, Kadem L. Accuracy of Doppler-echocardiographic parameters for the detection of aortic bileaflet mechanical prosthetic valve dysfunction. Eur Heart J Cardiovasc Imaging. 2014;15:142–51

  13. Ben Zekry S, Saad RM, Ozkan M, et al. Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. J Am Coll Cardiol Img. 2011;4:1161–70.

    Google Scholar 

  14. Mahjoub H, Mathieu P, Senechal M, et al. ApoB/ApoA-I ratio is associated with increased risk of bioprosthetic valve degeneration. J Am Coll Cardiol. 2013;61:752–61.

    CAS  PubMed  Google Scholar 

  15. Picano E, Pibarot P, Lancellotti P, Monin JL, Bonow RO. The emerging role of exercise testing and stress echocardiography in valvular heart disease. J Am Coll Cardiol. 2009;54:2251–60.

    PubMed  Google Scholar 

  16. Levy F, Donal E, Biere L, et al. Hemodynamic performance during exercise of the new St. Jude Trifecta aortic bioprosthesis: results from a French multicenter study. J Am Soc Echocardiogr. 2014;27:590–7.

    PubMed  Google Scholar 

  17. Alton ME, Pasierski TJ, Orsinelli DA, Eaton GM, Pearson AC. Comparison of transthoracic and transesophageal echocardiography in evaluation of 47 Starr-Edwards prosthetic valves. J Am Coll Cardiol. 1992;20:1503–11.

    CAS  PubMed  Google Scholar 

  18. Daniel LB, Grigg LE, Weisel RD, Rakowski H. Comparison of transthoracic and transesophageal assessment of prosthetic valve dysfunction. Echocardiography. 1990;7:83–95.

    Article  CAS  PubMed  Google Scholar 

  19. Vitarelli A, Conde Y, Cimino E, et al. Assessment of severity of mechanical prosthetic mitral regurgitation by transoesophageal echocardiography. Heart. 2004;90:539–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451–96.

    PubMed  Google Scholar 

  21. Jain S, Malouf JF. Incremental value of 3-D transesophageal echocardiographic imaging of the mitral valve. Curr Cardiol Rep. 2014;16:439.

    PubMed  Google Scholar 

  22. Bloomfield GS, Gillam LD, Hahn RT, et al. A practical guide to multimodality imaging of transcatheter aortic valve replacement. J Am Coll Cardiol Img. 2012;5:441–55.

    Google Scholar 

  23. Clavel MA, Rodes-Cabau J, Dumont E, et al. Validation and characterization of transcatheter aortic valve effective orifice area measured by Doppler echocardiography. J Am Coll Cardiol Img. 2011;4:1053–62. This is the first validation of the method to measure the EOA of transcatheter aortic valves by Doppler-echocardiography.

    Google Scholar 

  24. Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg. 2013;145:6–23. This article presents the recommendations for the Doppler-echocardiographic assessment of transcatheter aortic valves.

    PubMed  Google Scholar 

  25. Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585–95. This meta-analysis reports the prevalence and impact on prognosis of paravalvular regurgitation following TAVI.

    PubMed  Google Scholar 

  26. Ribeiro HB, Le Ven F, Larose E et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation. Heart. 2014;100:1924–32.

  27. Goncalves A, Almeria C, Marcos-Alberca P, et al. Three-dimensional echocardiography in paravalvular aortic regurgitation assessment after transcatheter aortic valve implantation. J Am Soc Echocardiogr. 2012;25:47–55.

    PubMed  Google Scholar 

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Acknowledgments

P. Pibarot holds the Canada Research Chair in Valvular Heart Disease and his research program is funded by Canadian Institutes of Health Research (Ottawa, Ontario, Canada) and Heart and Stroke Foundation of Québec (Montreal, Québec, Canada).

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Haïfa Mahjoub and Jean-Gaston Dumesnil declare that they have no conflict of interest.

Philippe Pibarot received research grants from Edwards Lifesciences for Echocardiography Core Laboratory analyses of transcatheter heart valves, and speaker honoraria from St. Jude Medical.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Institut Universitaire de Cardiologie et de Pneumologie de Québec / Québec Heart and Lung Institute, Department of Medicine, Laval University, 2725 Chemin Sainte-Foy, Québec, Québec, Canada, G1V-4G5

    Haïfa Mahjoub, Philippe Pibarot & Jean-Gaston Dumesnil

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  1. Haïfa Mahjoub
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  2. Philippe Pibarot
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  3. Jean-Gaston Dumesnil
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Corresponding author

Correspondence to Philippe Pibarot.

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This article is part of the Topical Collection on Echocardiography

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Mahjoub, H., Pibarot, P. & Dumesnil, JG. Echocardiographic Evaluation of Prosthetic Heart Valves. Curr Cardiol Rep 17, 48 (2015). https://doi.org/10.1007/s11886-015-0602-z

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  • DOI: https://doi.org/10.1007/s11886-015-0602-z

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