ECHO-Prosthetic Valve Assessment

Question 1

Types of prosthetic valve

Answer 1

• cadaveric homograft
• autograft (Ross procedure)
• Stented/stentless xenografts
• Mechanical

Question 2

key difference between surgical vs transcatheter valve

Answer 2

see pi

Question 2

what to look in an aortic homograft/heterograft/autograft?

Answer 2

resembles native valve

Question 2

What to look in a prosthetic valve?

Answer 2

inspect all elements
- Sewing ring/Transcatheter valve stent
- Cusps
- Vegetations
- color doppler flow

Question 3

what to look in a surgical bioprosthetic

Answer 3

struts
sewing ring
cusps

Question 4

What to measure in aortic and valve prostheses?

Answer 4

• gradient and velocity
• EOA/EOAi
• AV velocity / LVOT Velocity
• AT (Acceleration time)

Question 4

characteristics of a bileaflet mechanical prosthesis

Answer 4

see pic

Question 4

consideration for immobile cusp (prosthetic valve)

Answer 4

• thrombus
• degeneration
• endocarditis

Question 5

What to measure in tricuspid and pulmonary prostheses?

Answer 5

see pic

Question 6

how to measure LVOT if there is Aortic prostheses

Answer 6

see pic

Question 7

Normal gradient after TAVR

Answer 7

depends on the type of valve

considered abnormal:
- >20 mmHg
- increase of >10mmHg
***increase >50% from baseline

Question 8

What is Dimensionless Velocity Index (Aortic prostheses)

Answer 8

DVI = LVOT velocity/AV velocity

Question 8

Cut off value for Acceleration time for significant stenosis (Aortic prostheses)

Answer 8

> 100ms

Question 9

what to measure for mitral prostheses?

Answer 9

• mean gradient at HR
• PHT
• EOA
• MVP ratio
• presence, location and severity

Question 9

Formula for Effective orifice area (Aortic Prosthesis)

Answer 9

LVOT Area x LVOT VTI / AVP VTI

***AVP - aortic valve prostheses

Question 9

What is aortic patient prostheses mismatch?

Answer 9

the valve is too small for the patient’s body size

• check for EOAi
  cut off ≤0.65 ( ≤55 for BMI ≥30)

Question 10

EOA for mitral prostheses

Answer 10

see pic

Question 10

Normal gradient for mitral prostheses

Answer 10

depends if bioprosthetic or mechanical

Question 11

PHT for mitral prosthesis

Answer 11

stenosis >200ms

Question 11

mitral patient prostheses mismtach

Answer 11

check for EOAi

Question 12

Mitral valve prosthesis ratio

Answer 12

check for unrecognized MR

Question 13

what to consider if there is a HIGH gradient during prosthetic valve assessment?

Answer 13

consider:
- Obstruction
- PPM - patient prosthetic mismatch
- High flow
- Pressure recovery

**PPM - most overdiagnosed
**High cardiac output - most underdiagnosed

Question 14

cut off parameters for aortic prosthetic valve stenosis

Answer 14

see pic

Question 15

cut off parameters for mitral prosthetic valve stenosis

Answer 15

see pic