Adult Echocardiography Lecture 11 Prosthetic Valves Holdorf

Mechanical Valves Durable but need blood thinners Caged ball valves Starr-Edwards Smeloff-Cutter Braunwald-Cutter Magovern-Cromie Caged Disc Valves Kay-Suzuki Kay-Shiley Cooley-Cutter Beall Cross-Jones

Bileaflet (bi-disc, bi-poet) Titling-Disc Valves Wada-Cutter Bjork-Shiley Lillehei-Kaster Metronic-Hall Bileaflet (bi-disc, bi-poet) ST. JUDE CarboMedics Know what a ball and cage MV looks like Know that St. Jude is a bi-leaflet valve

Bioprosthetic (Tissue) valves No blood thinners but not as durable Homografts or allograft (same species)(Cryo-preserved) Stented Unstented Dura mater (brain covering) Heterografts (different species) Hancock Carpentier-Edwards St. Jude Lonescu-Shiley

Know that autografts use the patient’s own tissue AUTOGRAFTS (patient’s own tissue) Fascia Lata (thigh muscle covering)

Etiology Native valves are replaced for stenosis, regurgitation, or infection Valve repairs (mostly mitral) are becoming more common with Carpentier and Duran rings or annuloplasties. Pathophysiology Complications include: systemic embolization, perivavlular leaks, valve degeneration, ring abscess, thrombus, or pannus formation, endocarditis and hymolysis. All prosthetic valves have a transvalvular gradient. Most mechanical valves have some built-in regurgitation.

Physical signs Echo Mechanical valves will have a valve/poppet click Echo findings are specific to each different valve Valve apparatus will be highly echogenic and may mask adjacent structures Mechanical valve motion is best studied by M-mode to record maximum poppet/disc motion TEE helpful for the evaluation of vegetations or thrombi.

Note: Acoustic shadowing with mitral valve prosthesis. Note: Know echo appearance of common valves. Know the term pannus = host tissue overgrowth

Starr-Edwards Ball and Cage heart valve

Ball and Cage Mitral Valve Prosthesis

Doppler Normal prosthetic valves will have some transvalvular gradient Normal mechanical prosthetic valves will have some regurgitation Valves should be checked for peri-prosthetic (around the sewing ring) leaks. Valve apparatus may mask Doppler flows TEE necessary for evaluating MR, especially intraoperative monitoring of perivavlular leaks or success of valvuloplasties

Measure peak and mean gradients across all valves General gradients (may be higher with Starr-Edwards) Mitral – 1.5 -2 m/sec peak vel. 3-7 mm Hg mean gradient Aortic – 2-3 m/sec peak vel. 14-20 mm Hg mean gradient

The normal pressure half-time for a mitral prosthetic valve is: <170 m/sec Think of dividing 220 (constant from mital P ½ time equation) by both 170 and 280. Which would give you a larger valve area? Much better to repair a valve than to replace it.