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Prosthetic Valves Flashcards

1
Q
A

Mechanical mitral valve demonstrating:

  • acoustic shadowing and reverberation artifact (panel A)
  • artifact masking significant MR (panel B)
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2
Q

What is one problem with placement of a prosthetic ring or band and also with MitraClip?

A
  • assessment of residual regurgitation due to acoustic shadowing
  • obstruction is also possible

***specific recommendations regarding echocardiography in valve repair procedures are not addressed in the current imaging guidlines

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3
Q

What is the most frequently surgically implanted biologic valve?

A

stented xenograft

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4
Q

What is the most frequently surgically implanted mechanical valve?

A

bileaflet valve

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5
Q

What does the reported size (in millimeters) of a valve refer to?

A

outer diameter of the valve sewing ring

  • variations in sizing conventions between different manufacturers and, therefore, one should not compare the size between different valve types
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6
Q
A

Mechanical valve - bileaflet

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7
Q
A

Mechanical valve - single leaflet

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8
Q
A

Mechanical valve - Caged-ball

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9
Q
A

Stented Biologic (bioprosthetic) valve

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10
Q
A

Stentless Biologic (bioprosthetic) valve

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11
Q
A

Percutaneous biologic (bioprosthetic) valve

  • mild paravalvular AR (arrow) in the percutaneous valve
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12
Q
A
  • Sapien XT and Sapien 3
    • balloon-expandable TAVR valve
    • has a cobalt chromium fram with a fabric skirt mounted on the inside of a stent
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13
Q

What are the major types of prosthetic heart valves?

A
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14
Q

What are the major designs and models of biological replacement heart valves?

A
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15
Q

What are the major designs and models of mechanical replacement heart valves?

A
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16
Q
A

Parasternal short access of Mitra Clip placed at A2/P2

  • note presence of dual orifice appearance
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17
Q

What equation can be used to obtain MVA during cardiac catheterization?

A
  • Hakki equation
    • MVA = CO (L/min) / √mean pressure gradient (mm Hg)
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18
Q

What are common errors / problems when obtaining MVA during cardiac catheterizaton (Hakki equation)?

A
  • subject to erros in estimation of CO
  • failure to simltaneously measure left atrial (LA) and LV pressure
  • Concomitant regurgitation
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19
Q

What is the problem when utilizing PCWP in place of LA pressure to determine MVA during cardiac catheterization (Hakki equation)?

A

measurement of PCWP in place of LA pressure may overestimate gradient and underestimate MVA

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20
Q

Define patient prosthesis mismatch (PPM)

A

refers to the situation in which the effectiv orifice area (EOA) of a prosthesis is too small relative to the patients body size –> resulting in abnormally high postoperative gradients

21
Q

What are two situations in which bioprosthetic valves are utilized over mechanical valves?

A
  • Pregnancy (anticipating)
  • History of IVDA
22
Q

What are 3 priniciples that must be understood by both sonographer and interpreting echocardiographer in the assessment of prosthetic vavles?

A
  • All prosthetic valves have some inherent obstruction (which varies based on valve type and size), which can make differentiating between normal and pathologic gradients challenging.
  • Prosthetic valves have inherent transprostetic regurgitation that must not be confused with pathologic regurgitation.
  • Acoustic shadowing and other artifacts such as reverberations can make evaluation fo the structure of the valve and presence/degree of regurgitation difficult
23
Q

What is the EOA (indexed) cutoff in regards to PPM for a prosthesis in the aortic position?

A

EOA indexed ≤ 0.85 cm2 / m2

  • smaller areas –> rapid increase in transvalvular gradients
24
Q

What is the EOA (indexed) cutoff for severe PPM for a prosthesis in the aortic position?

A

EOA indexed ≤ 0.65 cm2 / m2

25
Q

What are the major adverse outcomes associated with PPM?

A

short-term and long-term survival

particularly if associated with LV dysfunction

26
Q

What peak velocity should prompt further evaluation in assessment of aortic prosthetic valves?

27
Q

What is the severity scale for aortic prosthetic valves?

  • Peak velocity
A
  • Normal < 3 m/s
  • Possible stenosis 3-4 m/s
  • Significant stenosis > 4 m/s
28
Q

Describe the algorithm in evaluating aortic prosthesis with PV > 3 m/s

30
Q

Assessment of peak and mean gradients across the mitral/tricuspid valve prostheses are greatly dependent upon this?

A

Heart rate

  • gradients across mitral and tricuspid prostheses are very HR dependent
31
Q

What is the severity scale for mitral prosthetic valves?

  • Peak velocity
A
  • Normal < 1.9 m/s
  • Possible stenosis 1.9-2.5 m/s
  • Significant stenosis > 2.5 m/s
32
Q

What is the severity scale for mitral prosthetic valves?

  • Mean gradient
A
  • Normal ≤ 5 mmHg
  • Possible stenosis 6-10 mmHg
  • Significant stenosis > 10 mmHg
33
Q

What is the severity scale for aortic prosthetic valves?

  • Mean gradient
A
  • Normal < 20 mmHg
  • Possible stenosis 20-35 mmHg
  • Significant stenosis > 35 mmHg
34
Q

What is the severity scale for aortic prosthetic valves?

  • DVI
A
  • Normal ≥ 0.30
  • Possible stenosis 0.29 - 0.25
  • Significant stensosi ≤ 0.25
35
Q

What is the severity scale for mitral prosthetic valves?

  • VTIPrMV / VTILVOT
A
  • Normal < 2.2
  • Possible stenosis 2.2 - 2.5
  • Significant stenosis > 2.5
36
Q

What is the severity scale for mitral prosthetic valves?

  • EOA
A
  • Normal ≥ 2cm2
  • Possible stenosis 1-2 cm2
  • Significant stenosis < 1 cm2
37
Q

What is the severity scale for aortic prosthetic valves?

  • EOA
A
  • Normal > 1.2 cm2
  • Possible stenosis 1.2 - 0.8 cm2
  • Significant stenosis < 0.8 cm2
38
Q

What is the severity scale for mitral prosthetic valves?

  • PHT
A
  • Normal < 130 ms
  • Possible stenosis 130 - 200 ms
  • Significant stenosis > 200 ms
39
Q

What is the severity scale for aortic prosthetic valves?

  • Acceleration time (AT)
A
  • Normal < 80 ms
  • Possible stenosis 80 - 100 ms
  • Significant stenosis > 100 ms
40
Q

What are findings suggestive of prosthetic TS?

A
  • PV ≥ 1.7 m/s
  • MG ≥ 6 mmHg
  • PHT ≥ 230 ms
41
Q

What is the severity scale for aortic prosthetic valves?

  • jet velocity contour
A
  • Normal - triangular, early peaking
  • Possible stenosis - triangular to indeterminate
  • Significant stenosis - rounded, symmetrical contour
42
Q

What do microcavitations (in harmonic imaging) indicate in prosthetic valve assessment?

A

normal prosthetic valve

43
Q

What prosthetic valves demonstrate the greatest degree of pressure recovery?

A

Bileaflet (small)

and

Ball and cage

44
Q

In which mitral valve prosthesis is a large central jet most consistent with normal valve function?

A

Medtronic-Hall single disc valve

45
Q

What are the recommendations in regards to PHT in assessment of prosthetic valves?

A

Should not be used / Inaccurate

47
Q

What are four criteria used to identify constrictive pericarditis?

A
  • Ventricular inderdependence (septal motion abnormality)
  • Mitral inflow velocity ≥ Grade 2
  • Mitral annulus medial e’ ≥ 8 cm/s
  • Hepatic vein diastolic expiratory flow reversal
48
Q

In which mitral valve prosthesis is the largest degree of physiologic regurgitation seen?

A

Bileaflet valves

  • central and peripheral jets
49
Q

What is recommended whenever paravalvular regurgitation is suspected?

A

TEE

  • essential to the evaluation of paravavular regurgitation
51
Q

What are mimickers of constriction?

A
  • Restrictive cardiomyopathy
  • Severe TR
  • Ventricular interdependence (other causes)

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