1. Adult Echocardiography Lecture 11 Prosthetic Valves
Holdorf

2. 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

3. 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

4. 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

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

7. 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.

8. 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.

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

10. Starr-Edwards Ball and Cage heart valve

11. Ball and Cage Mitral Valve Prosthesis

14. 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

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

16. 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.