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Echo > Prosthetic Valves > Flashcards

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
Q

Doppler velocity index (DVI) / DI

A

LVOT velocity / prosthesis velocity
LVOT VTI / prosthesis VTI
Independent of flow conditions / prosthesis size

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26
Q

AV DI pathologic obstruction

A

<0.25

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27
Q

AV prosthetic stenosis EOA

A

LVOT area * LVOT VTI / prosthetic VTI

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28
Q

Normal AV prosthetic EOA

A

> 1.2

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29
Q

Possible obstruction EOA AV prosthetic

30
Q

Significant stenosis EOA AV prosthetic

31
Q

Indexed EOA (iEOA)

A

EOA / body surface area

Can differentiate pathologic from functional obstruction

32
Q

AV pathologic obstruction causes

A

Thrombus
Pannus
Thrombus + Pannus
Degeneration

33
Q

AV stenosis and significant regurgitation affects which parameters

A

Peak velocity and MG more flow dependent

34
Q

ASE AV stenosis algorithm

A

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
Q

Location for LVOT diameter

A

Calipers at insertion between sewing ring and base of septum or anterior mitral leaflet

36
Q

AV pressure recovery

A

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
Q

AV Prosthesis patient mismatch

A

EOA less than that of normal valve

Determined by indexed EOA

38
Q

Normal iEOA AV

39
Q

Moderate mismatch iEOA AV

40
Q

Severe mismatch iEOA AV

41
Q

AV essential doppler parameters

A

DI
AT
EOA
iEOA

42
Q

AV AT > 100 ms

A

Pathologic obstruction

43
Q

AV AT <= 100, iEOA <= 0.65

A

Severe PPM

44
Q

AV AT <= 100, iEOA > 0.85

A

Normal
High flow
Pressure recovery
Pathologic regurgitation

45
Q

MV stented pericardial normal MG

46
Q

MV stented porcine normal MG

47
Q

MV bileaflet mechanical normal MG

48
Q

MV single tilting disc normal MG

49
Q

MV caged ball normal MG

50
Q

MV E velocity dysfunction

51
Q

MV E velocity normal

52
Q

VTI ratio

A

VTI prosthesis / VTI LVOTI

53
Q

MV VTI ratio dysfunction

54
Q

MV VTI ratio normal

55
Q

MV PHT pathologic

56
Q

MV PHT normal, functional, regurgitation

57
Q

MV significant regurgitation pattern

A

VTI ratio >2.2

PHT < 130

58
Q

MV EOA

A

Do not use PHT
Use continuity equation (area LVOT x VTI LVOT / VTI prosthesis)
Not valid with significant AI or MR

59
Q

MV EOA Normal

60
Q

MV EOA possible obstruction

61
Q

MV EOA significant stenosis

62
Q

MV iEOA no PPM

63
Q

MV iEOA moderate PPM

64
Q

MV iEOA severe PPM

65
Q

Pressure recovery phenomenon

A

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
Q

Velocity through prosthetic AV which may prompt concern for pathologic obstruction

67
Q

Pressure recovery typically associated with

A

Small bileaflet mechanical valve

68
Q

MV most likely to have normal large central jet

A

Medtronic-Hall single disc valve

69
Q

Doppler velocity index (DVI)

A

Subvalvular velocity or VTI / prosthetic velocity or VTI

70
Q

TV prosthetic stenosis mean gradient

Echo (30 decks)

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