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Prosthetic Valves Flashcards

(48 cards)

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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)

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
A

EOA indexed ≤ 0.65 cm2 / m2

25
What are the major adverse outcomes associated with PPM?
short-term and long-term survival particularly if associated with LV dysfunction
26
What peak velocity should prompt further evaluation in assessment of aortic prosthetic valves?
**\> 3 m/s**
27
What is the severity scale for aortic prosthetic valves? * Peak velocity
* Normal \< 3 m/s * Possible stenosis 3-4 m/s * Significant stenosis \> 4 m/s
28
Describe the algorithm in evaluating aortic prosthesis with PV \> 3 m/s
30
Assessment of peak and mean gradients across the mitral/tricuspid valve prostheses are greatly dependent upon this?
**Heart rate** * gradients across mitral and tricuspid prostheses are very HR dependent
31
What is the severity scale for mitral prosthetic valves? * Peak velocity
* Normal \< 1.9 m/s * Possible stenosis 1.9-2.5 m/s * Significant stenosis \> 2.5 m/s
32
What is the severity scale for mitral prosthetic valves? * Mean gradient
* Normal ≤ 5 mmHg * Possible stenosis 6-10 mmHg * Significant stenosis \> 10 mmHg
33
What is the severity scale for aortic prosthetic valves? * Mean gradient
* Normal \< 20 mmHg * Possible stenosis 20-35 mmHg * Significant stenosis \> 35 mmHg
34
What is the severity scale for aortic prosthetic valves? * DVI
* Normal ≥ 0.30 * Possible stenosis 0.29 - 0.25 * Significant stensosi ≤ 0.25
35
What is the severity scale for mitral prosthetic valves? * VTIPrMV / VTILVOT
* Normal \< 2.2 * Possible stenosis 2.2 - 2.5 * Significant stenosis \> 2.5
36
What is the severity scale for mitral prosthetic valves? * EOA
* Normal ≥ 2cm2 * Possible stenosis 1-2 cm2 * Significant stenosis \< 1 cm2
37
What is the severity scale for aortic prosthetic valves? * EOA
* Normal \> 1.2 cm2 * Possible stenosis 1.2 - 0.8 cm2 * Significant stenosis \< 0.8 cm2
38
What is the severity scale for mitral prosthetic valves? * PHT
* Normal \< 130 ms * Possible stenosis 130 - 200 ms * Significant stenosis \> 200 ms
39
What is the severity scale for aortic prosthetic valves? * Acceleration time (AT)
* Normal \< 80 ms * Possible stenosis 80 - 100 ms * Significant stenosis \> 100 ms
40
What are findings suggestive of prosthetic TS?
* PV ≥ 1.7 m/s * MG ≥ 6 mmHg * PHT ≥ 230 ms
41
What is the severity scale for aortic prosthetic valves? * jet velocity contour
* Normal - triangular, early peaking * Possible stenosis - triangular to indeterminate * Significant stenosis - rounded, symmetrical contour
42
What do microcavitations (in harmonic imaging) indicate in prosthetic valve assessment?
**normal prosthetic valve**
43
What prosthetic valves demonstrate the greatest degree of pressure recovery?
**Bileaflet (small)** and **Ball and cage**
44
In which mitral valve prosthesis is a large central jet most consistent with normal valve function?
**Medtronic-Hall single disc valve**
45
What are the recommendations in regards to PHT in assessment of prosthetic valves?
**Should not be used** / **Inaccurate**
47
What are four criteria used to identify constrictive pericarditis?
* Ventricular inderdependence (septal motion abnormality) * Mitral inflow velocity ≥ Grade 2 * Mitral annulus medial e' ≥ 8 cm/s * Hepatic vein diastolic expiratory flow reversal
48
In which mitral valve prosthesis is the largest degree of physiologic regurgitation seen?
**Bileaflet valves** * central and peripheral jets
49
What is recommended whenever paravalvular regurgitation is suspected?
**TEE** * essential to the evaluation of paravavular regurgitation
51
What are mimickers of constriction?
* Restrictive cardiomyopathy * Severe TR * Ventricular interdependence (other causes)

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