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New Recommendations for Evaluation of Prosthetic Valves with Echocardiography and Doppler Ultrasound

Author:

William A. Zoghbi

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About William A.
M.D.
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Abstract

Overview

Valve replacement remains common in the adult patient despite advances in valve repair. While a physical examination can alert the clinician to the presence of valve dysfunction, diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography with Doppler is currently the method of choice for the non-invasive evaluation of prosthetic valves. A recently published “Guidelines and Standards” document from the American Society of Echocardiography (ASE)1 offers a review of echocardiographic and Doppler techniques used in assessing prosthetic valves and, for the first time, provides general recommendations for evaluating prosthetic valve function. The guidelines have been endorsed by prominent national and international professional health organizations including the American Heart Association, the American College of Cardiology, and the European Association of Echocardiography. I was honored to chair the ASE writing group of international experts on prosthetic valves and will review the salient features of these guidelines, particularly pertaining to the commonly implanted valves in the aortic and mitral positions.

Over the last 40 years, a large variety of prosthetic valves have been developed with the aim of improving hemodynamic function, increasing durability, and reducing complications. Nevertheless, there is no ideal valve, and all prosthetic valves are prone to dysfunction. The valve types now implanted include bileaflet and tilting-disc mechanical valves, stented porcine and pericardial xenografts, stentless porcine xenografts, cadaveric homografts, and autografts. Figure 1 shows examples of these valves and their echocardiographic images. The new ASE guidelines outline the importance of a comprehensive evaluation for optimal assessment of prosthetic valve function (Table 1). This involves obtaining pertinent clinical information, blood pressure and heart rate at the time of the examination, date of valve replacement, and type and size of the prosthetic valve since the latter affect valve hemodynamics. Imaging of the valve with transthoracic echocardiogram (TTE) from multiple views, with particular attention to motion of the leaflets or occluder, is recommended along with a comprehensive Doppler evaluation of velocity, gradients, and derivation of effective orifice area, where applicable. Selected indications for transesophageal echocardiography (TEE) to evaluate structural abnormalities, complications, and regurgitation is highlighted (Table 2). Lastly, since most prosthetic valves are inherently mildly stenotic, and velocities and gradients differ significantly among them, a baseline Doppler echocardiographic study is strongly recommended early after surgery for comparison in the serial assessment of valve function.

How to Cite: 1. Zoghbi WA. New Recommendations for Evaluation of Prosthetic Valves with Echocardiography and Doppler Ultrasound. Methodist DeBakey Cardiovascular Journal. 2010;6(1):20-26. DOI: http://doi.org/10.14797/mdcvj.189
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Published on 01 Jan 2010.
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