ECHO 2013 / Echocardiography for Assessment of Prosthetic Heart Valves
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Mechanical MVR
Increased MG
Increased T1/2 |
Normal T1/2 |
Obstructed |
Significant MR, High Output |
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or P-PtM |
Prosthesis TVI / LVOT TVI ratio > 2.2
Mitral Prosthesis Hemodynamics*
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Type of Mitral Prosthesis |
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Carpentier |
Carbomedi |
Starr- |
St. Jude |
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Edwa rds |
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Edwa rds |
Medical |
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Duraflex |
N = 79 |
N = 47 |
N = 119 |
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N = 252 |
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Age, years |
73 |
55 |
59 |
58 |
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Women, No. (%) |
(138) 55 |
55 (70) |
23 (49) |
81 (68) |
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Heart rate, beats/min |
80 |
85 |
85 |
82 |
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BSA, m2 |
1.85 |
1.88 |
1.87 |
1.82 |
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LVEF, % |
54 |
52 |
52 |
56 |
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LVEF <50%, No. |
63 (25) |
25 (32) |
15 (32) |
28 (24) |
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(%) |
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SV, ml |
76 |
67 |
67 |
60 |
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PHT, ms |
81 |
71 |
79 |
71 |
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M G, mmHg (all |
6.83 |
5.1 |
5.25 |
4.49 |
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patients) |
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EVLCTY, m/s |
2.04 |
1.69 |
1.65 |
1.66 |
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TVIMVP, cm |
49 |
32 |
35 |
33 |
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EVLCTY/TVILVOT |
0.09 |
0.09 |
0.09 |
0.09 |
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TVIMVP/TVILVOT |
2.19 |
1.70 |
1.86 |
1.72 |
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EOA |
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CON, cm2 |
1.57 |
2.25 |
1.95 |
1.91 |
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PHT, cm2 |
2.87 |
3.28 |
2.91 |
3.28 |
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IEOA |
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CON |
0.85 |
1.22 |
1.05 |
1.07 |
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PHT |
1.58 |
1.79 |
1.58 |
1.85 |
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EOA |
0.05 |
0.08 |
0.06 |
0.07 |
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CON/prosthesis size |
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EOA PHT/prosthesis |
0.10 |
0.11 |
0.09 |
0.11 |
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size |
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PPI CON |
~0.30 |
0.53 |
0.57 |
0.44 |
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Blauwet L; JASE 2009 |
* Mean values |
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Normal Values Defined for Echocardiographic Variables
•Mean+SD (range) for all variables
•Measured variables
•E velocity, MG, PHT, TVIMVP and TVILVOT
•Calculated variables
•SV and SVI
•EOA by PHT method and continuity equation
•IEOA by PHT method and continuity equation
•Prosthesis Performance Index (PPI: EOA/GOA)
•Mean+2SD used as cut-off values for upper
limit of normal
Blauwet LA; JASE 2009; accepted for publication
Older vs Newer Generation Porcine MVP
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Bioprosthesis Type |
Mean Gradient |
E velocity |
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(mmHg) |
(m/s) |
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Older Generation |
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Medtronic Hancock I |
3.9 – 5.0 |
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Ionescu-Shiley |
3.2 – 4.9 |
1.4 |
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Ionescu-Shiley low profile |
2.7 – 3.3 |
1.4 |
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Wessex |
3.3 – 3.7 |
1.4 |
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Newer Generation |
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Carpentier-Edwards Duraflex |
6.2 – 7.0 |
2.0 |
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Medtronic Mosaic |
6.3 – 7.4 |
1.9 |
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Blauwet LA; JASE 2009; accepted for publication
Hemodynamics* Differ Between MVP
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Mean |
E Velocity |
TVIMVP |
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PHT |
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Prosthesis Type |
Gradient |
TVIMVP/TVILVOT |
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(m/s) |
(cm) |
(msec) |
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(mmHg) |
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Mechanical
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Starr-Edwards |
5.3 |
1.7 |
35 |
1.9 |
79 |
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St. Jude Medical |
4.5 |
1.7 |
33 |
1.7 |
71 |
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CarboMedics |
4.8 |
1.7 |
32 |
1.7 |
71 |
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Porcine
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Carpentier-Edwards Duraflex |
6.7 |
2.0 |
49 |
2.4 |
81 |
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Medtronic Hancock II |
6.3 |
1.9 |
46 |
2.3 |
78 |
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Medtronic Mosaic |
6.2 |
2.0 |
48 |
2.2 |
77 |
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St. Jude Medical BioCor |
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Pericardial
Carpentier-Edwards Perimount |
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5.8 |
1.8 |
41 |
1.9 |
76 |
*mean values
Mitral Prosthesis-Patient Mismatch
•Severe mismatch currently defined as EOAI < 0.9 cm2/m2
•This results in large mean gradient
•In our experience, the pressure halftime is always less than 130 msec with severe mismatch, so this can help to separate functional from pathologic obstruction of MV prosthesis
Blauwet LA
Journal of the American Society of Echocardiography
2009
Mitral PPM Can Cause Functional
Mitral Valve Prosthesis Stenosis
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Mean |
E Velocity |
TVIMVP |
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PHT |
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Prosthesis Type |
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Gradient |
TVI ratio |
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(m/s) |
(cm) |
(msec) |
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(mmHg) |
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Medtronic Hancock II |
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All patients |
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10.2 |
2.6 |
71 |
3.7 |
116 |
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Patients with severe PPM |
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9.9 |
2.6 |
75 |
3.7 |
121 |
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Patients without severe PPM |
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10.7 |
2.5 |
56 |
2.8 |
103 |
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Medtronic Mosaic |
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All patients |
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9.8 |
2.7 |
73 |
3.6 |
109 |
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Patients with severe PPM |
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9.9 |
2.7 |
73 |
3.8 |
110 |
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Patients without severe PPM |
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9.5 |
2.7 |
70 |
2.5 |
105 |
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Carpentier Edwards Perimount |
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All patients |
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8.7 |
2.3 |
58 |
2.8 |
112 |
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Patients with severe PPM |
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9.3 |
2.3 |
60 |
3.0 |
116 |
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Patients without severe PPM |
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8.3 |
2.3 |
57 |
2.5 |
107 |
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*Mean+2SD
29 mm Carpentier-Edwards Duraflex Mitral Valve prosthesis
Pathologic MVP Stenosis |
Functional MVP Stenosis |
PHT 139 msec
E velocity 2.3 m/s |
MG |
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9 mmHg TVI ratio |
2.7 |
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IEOA |
0.75 cm2/m2 |
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PHT 51 msec
E velocity 2.3 m/s
MG |
9 mmHg |
TVI ratio |
2.7 |
IEOA |
0.73 cm2/m2 |
Mayo Clinic
Locations
©2011 MFMER | slide-60