Prosthetic Valves Flashcards
which is pathologic and which is functional AV stenosis, why?
Left= pathologic (rounded doppler/AT>100
Right= functional
Less than or equal to how much = AV prosthesis FUNCTIONAL stenosis?
100 m/s
(so longer AT = pathologic)
another name for dimensionless index?
Doppler velocity index
eq’n for Dimensionless Index for AV Prosthesis (and types of doppler to use in numerator and denominator)?
DI= Velocity lvot/Velocity avp= TVI LVOT/TVI AVP
(LVOT w/ PW, AVP w/ CW)
Dimensionless Index = pathologic obstruction of Prosthetic OR Native AV?
< 0.25
3 things that define FUNCTIONAL obstruciton of a prosthetic valve
PPM
high flow
pressure recovery
Use continuity eq’n to calculate EOA of AVP
AVP Area = SV/TVI AVP
(SV = Alvot x TVI LVOT)
eq’n for indexed EOA (iEOA); what can it help differentiate for a prostethic valve?
iEOA = EOA/BSA
functional vs. pathologic obstruction
which 2 variables in severeity if AVP obstruction are affected by AR, low flow, etc.?
Peak Velocity
Mean gradient
Severe AVP obstruction: Mean gradient, DI, EOA
>35
<0.25
<0.8
EOA for Normal and severe AVP obstruction
Normal EOA > 1.2 cm^2
Severe AVPS
can a dysfunctional AVP have a normal peak velocity and mean gradient?
yes
In evaluating AVP if you get a peak velocity > 3m/s (high), but normal DI (or DVI) and normal AT, what can the diagnosis be (x2)? What to use to diagnose these?
High Flow or PPM (iEOA)
what can aacount for different calculaitons of pressure/velovity across a prosthetic AV in cath lab vs. echo?
pressure recovery location used
what is Aortiv Valve PPM determined by? what is normal and what is severe?
iEOA
No AV PPM if > 0.85
Severe AV PPM if < 0.65
(cut offs different for MV)
name 3 things causing higher mortality with PPM
<70 y/o
BMI < 30
Low EF
in AVP, what does iEOA > 0.85 indicate?
High Flow
when measuring PW to calculate EOA of TAVR prosthesis, where do you place sample volume and why?
- outside cage
- if PW placed within stent/proximal to cusps to measure LVOT velocity, EOA is OVERESTIMATED. B/c flow acceleration happens twice for TAVR prostheses)
for AVP, if MG is less than expected (>35 is severe AVPS), what do you do?
use multiple windows to get CW doppler
for AVP: MG>35 , DI< 0.25, AT >100ms, rounded jet =?
Pathologic stenosis
for AVP: MG> 35, DVI (DI) > 0.25, AT <100ms, triangular jet = ? ; how do you differentiate the types?
Functional Stenosis
iEOA < 0.65 = PPM
iEOA > 0.85 = Pressure Recovery
do you use CW or PW for E velocity?
CW
MVP TVI ratio
TVI mvp/TVI lvot
(inverse for AVP)
PHT> ? E >? indicates severe MVP obstruction?
PHT > 130ms
E > 1.9m/s
why can you NOT use 220/PHT to calculate EOA of MV Prosthesis?
overestimates EOA
do you use continuity eq’n or 220/PHT to calculate Prosthetic MVA?
continuity eq’n (cant use if severe AR or MR)
Normal values and Severe MVP stenosis for Peak Velocity? MG? TVI Ratio?
Peak Velocity: <1.9 or > 2.5
MG < 5 or >10
TVI Ratio: <2.2 or > 2.5
for Prosthetic MV, what is normal iEOA, what is severe stenosis?
Normal iEOA > 1.2
MVPS, iEOA < 0.9
Prosthetic MV w/ MG> 10, but PHT<130 and TVI Ratio > 2.2, iEOA > 1.2. Diagnosis?
regurgitation
Prosthetic MV MG> 10, but PHT < 130 and:
TVI Ratio <2.2
iEOA > 1.2
DIagnosis?
High output
Prosthetic MV MG> 10, but PHT < 130 and:
TVI Ratio < 2.2
iEOA < 1.2
Diagnosis?
PPM
Best initial test (AUC criteria) for prostehtic valve endocarditis?
TTE (can jump straight to TEE if mod-high pre-test probability)
