Patient-Prosthesis Mismatch

Question 1

What is etiology of PPM

Answer 1

1) Pts with aortic valve disease have annulus calcification and fibrosis which can reduce the size of the aortic annulus.
2) Stented prosthesis is inserted within the aorta and has is own annulus, the EOA after implantation is necessarily smaller than that of a normal native valve.

Question 2

What is Effective Orifice Area and what is Geomertic orifice area

Answer 2

EOA: is a physiological parameter that represents the minimal cross-sectional areas of the the trans-prosthetic blood flow jet and is easily measured by Doppler echocardiopgraphy.

GOA: Anatomical parameter calculated from the static measurement of the internal diameter of the prosthesis. Unfortunately, the GOA measurement varies from one type of prosthesis to the other while the ratiio between EOA and GEO also varies widely from one type and/or size of prosthesis to another.

Question 3

What is EOAi

Answer 3

The only parameter that has been validated to identify PPM is the “indexed” EAO, that is the EAO of the prosthesis divided by the the BSA

EOAi = EOA/BSA

Question 4

List 3 studies examining PPM in aortic position

Answer 4

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Question 5

What is management of mitral valve PPM

Answer 5

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Question 6

What is definition of PPM

Answer 6

The effective prosthetic valve areas, after insertion into the patient is less than that of a normal human valve.

PPM deemed to occur when the effective orifice areas of the implanted prosthetic valve is too small in relation to the patient’s body size, despite normal prosthesis function, resulting in an abnormally high postoperative pressure gradient.