Prosthetic Heart Valves

Question 1

Bioprosthetic (Tissue) Valves types

Answer 1

(no blood thinners needed, not as durable)

• autograft (self to self): pulmonic valve to aortic position
• homograft (allograft): same species, cryo-preserved
• heterograft (xenograft): different species
• PORCINE: pig’s aortic valve (Brands: Hancock, Carpentier-Edwards)
• Bovine pericardium: cows pericardium made into a trileaflet (Brands: Carpentier-Edwards, Ionescu-Shiley, Mitroflow)

Question 2

Prosthetic Complications

Answer 2

• calcification/degeneration— functional failure
• infective endocarditis
• dehiscence
• thrombus
• stenosis
• perivalvular leak
• valve bed abnormalities

Question 3

Echo

Answer 3

• specific to each different valve
• valve apparatus will be highly echogenic
• mechanical valve motion is best studied by M-mode
• Dehisced valve will “rock” relative to attachment
• TEE helpful for thrombi or vegetations

Question 4

m-mode

Answer 4

• leaflet thickness >3 mm is abnormal
• Coarse flutter of the tissue leaflets is abnormal
• Evaluate left ventricular function

Question 5

2-D/Doppler

Answer 5

• evaluate left ventricular function
• acoustic shadowing
• aortic valve pressure gradient >45 mmHg may be abnormal

Question 6

Mechanical Valves Types

Answer 6

• Ball and cage (Starr-Edwards is most common)
• Caged disc (Beall)
• Tilting Disc (Bjork-Shiley, Medtronic Hall are most common)
• Bileaflet (St. Jude is most popular) (least stenotic valve)

Question 7

Mechanical Complications

Answer 7

-thrombus
-pannus (fibrous ingrowth of tissue)
-perivalvular leak
-Dehiscence
-infective endocarditis
-hemolysis
-ball/disc variance
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