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Prosthetic Valves Flashcards

1
Q

Types of aortic bioprostheses

A

Cadaveric homograft
Autograft (Ross)
Stented / stentless xenografts

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2
Q

Aortic cadaveric homograft

A

Bioprosthetic, rare
Looks like regular valve
None to trivial central regurgitation

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3
Q

Stented / stentless aortic bioprostheses

A 
Porcine
Pericardial
Bovine
Stented - see seats on echo
Stentless
Transcatheter
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4
Q

Normal bioprosthetic valve regurgitation

A

No or trivial central regurgitation

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5
Q

Mechanical aortic bioprostheses

A

Caged ball
Single tilting disc
Bileaflet

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6
Q

Mechanical prosthesis regurgitation

A

Built-in washing jets with prosthetic regurgitation

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7
Q

Aortic caged ball

A

Ball going up and done in cage

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8
Q

Aortic single tilting disc

A

Single disc going up and down

Big puff of central regurgitation

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9
Q

Aortic bileaflet mechanical valve

A

Most common
Two occluders / leaflets open up and down, don’t go to 90’
Central and side jets

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10
Q

Periprosthetic regurigtation

A

Always pathologic

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11
Q

Assessment of aortic prosthetic stenosis

A

2D and doppler variables
EOA by continuity equation
Normal ranges
Correct measurement of LVOT VTI and LVOT diameter

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12
Q

Aortic homograft normal MG

A

2-3

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13
Q

Stentless pericardial AV normal MG

A

8-9

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14
Q

Stented pericardial AV normal MG

A

10-15

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15
Q

Stented porcine AV normal MG

A

10-20

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16
Q

Bileaflet mechanical AV normal MG

A

5-10-15

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17
Q

Single tilting disc AV normal MG

A

15-20

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18
Q

Caged ball AV normal MG

A

20-25

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19
Q

AV prosthetic CW jet rounded

A

Most likely pathologic obstruction

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20
Q

AV prosthetic CW jet pointed

A

Normal
Functional obstruction
Regurgitation

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21
Q

Functional AV obstruction

A

High flow
Pressure recovery
PPM

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22
Q

Acceleration time

A

Time from onset of flow (just inside opening click) to peak velocity

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23
Q

Pathologic AV prosthetic AT

A

> 100 ms - pathologic obstruction

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24
Q

AV prosthetic AT <100 ms

A

Normal
Functional obstruction
Regurgitation

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25
Doppler velocity index (DVI) / DI
LVOT velocity / prosthesis velocity LVOT VTI / prosthesis VTI Independent of flow conditions / prosthesis size
26
AV DI pathologic obstruction
<0.25
27
AV prosthetic stenosis EOA
LVOT area * LVOT VTI / prosthetic VTI
28
Normal AV prosthetic EOA
>1.2
29
Possible obstruction EOA AV prosthetic
0.8-1.2
30
Significant stenosis EOA AV prosthetic
<0.8
31
Indexed EOA (iEOA)
EOA / body surface area | Can differentiate pathologic from functional obstruction
32
AV pathologic obstruction causes
Thrombus Pannus Thrombus + Pannus Degeneration
33
AV stenosis and significant regurgitation affects which parameters
Peak velocity and MG more flow dependent
34
ASE AV stenosis algorithm
Peak velocity > 3 m/s DVI <0.25, contour round, AT > 100 = pathologic, calculate EOA DVI < 0.25, contour pointed, AT < 100 = PW doppler sample too far from prosthesis DVI 0.25-0.29, contour round, AT > 100 = pathologic DVI 0.25-0.29, contour pointed, AT <100 = normal, check EOA index DVI >= 0.30, jet pointed, AT < 100 = normal DVI >=0.30, jet round, AT > 100 = stenosis with sub-valve narrowing, underestimated gradient, improper LVOT velocity (too close to prosthesis)
35
Location for LVOT diameter
Calipers at insertion between sewing ring and base of septum or anterior mitral leaflet
36
AV pressure recovery
Pressure / velocity difference between central vena contracta (where echo measures) close to valve and vena contracta further into aortic root (where Cath measures) More common smaller aortic root, small bileaflet mechanical valve
37
AV Prosthesis patient mismatch
EOA less than that of normal valve | Determined by indexed EOA
38
Normal iEOA AV
>0.85
39
Moderate mismatch iEOA AV
0.66-0.85
40
Severe mismatch iEOA AV
<=0.65
41
AV essential doppler parameters
DI AT EOA iEOA
42
AV AT > 100 ms
Pathologic obstruction
43
AV AT <= 100, iEOA <= 0.65
Severe PPM
44
AV AT <= 100, iEOA > 0.85
Normal High flow Pressure recovery Pathologic regurgitation
45
MV stented pericardial normal MG
4-7
46
MV stented porcine normal MG
6-9
47
MV bileaflet mechanical normal MG
3-6
48
MV single tilting disc normal MG
4-6
49
MV caged ball normal MG
7-10
50
MV E velocity dysfunction
>= 1.9
51
MV E velocity normal
<1.9
52
VTI ratio
VTI prosthesis / VTI LVOTI
53
MV VTI ratio dysfunction
>2.2
54
MV VTI ratio normal
<2.2
55
MV PHT pathologic
>= 130
56
MV PHT normal, functional, regurgitation
<130
57
MV significant regurgitation pattern
VTI ratio >2.2 | PHT < 130
58
MV EOA
Do not use PHT Use continuity equation (area LVOT x VTI LVOT / VTI prosthesis) Not valid with significant AI or MR
59
MV EOA Normal
>2.0
60
MV EOA possible obstruction
1.0-2.0
61
MV EOA significant stenosis
<1.0
62
MV iEOA no PPM
>1.20
63
MV iEOA moderate PPM
0.91-1.20
64
MV iEOA severe PPM
<= 0.90
65
Pressure recovery phenomenon
Localized pressure drop at the central orifice of a bileaflet mechanical valve is partially recovered distally as flow from lateral two orifices merges with central flow jet
66
Velocity through prosthetic AV which may prompt concern for pathologic obstruction
<3 m/s
67
Pressure recovery typically associated with
Small bileaflet mechanical valve
68
MV most likely to have normal large central jet
Medtronic-Hall single disc valve
69
Doppler velocity index (DVI)
Subvalvular velocity or VTI / prosthetic velocity or VTI
70
TV prosthetic stenosis mean gradient
>6

Echo (30 decks)

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