1. Prosthetic Valve Dysfunction

2. Prosthetic Valve Dysfunction
It is important that each patient who is to be
examined either by cath or echo be questioned about pertinent medical history, symptoms and current medications.
Usually this information is in the patient’s chart.
Identification cards are usually issued to a
patent indicating the type of valve and
diameter and size, this is important for
comparison

3. Prosthetic Valve Dysfunction
– Mechanical failure:
Any problem with the prosthetic valve structure
either mechanical or bioprosthetic such as ball or
disc variance, thrombus, pannis, endocarditis.

4. Prosthetic Valve Dysfunction
Tissue degeneration
– Infective endocarditis or ring abscess
– Loose or torn structures
– Calcific changes
– Thromboembolic complications (blood stagnation,
eddies, high shear stress contribute to blood
clotting)

5. Valve Dysfunction
Early postoperative study, either prior to hospital discharge or within the first two months thereafter, should be performed as a baseline for subsequent comparison.

6. Valve Dysfunction
Physical examination suggests valve dysfunction, on the basis of murmurs or other findings such as peripheral or cerebral emboli, or endocarditis, deterioration of cardiac function, such as a new heart failure or other significant cardiac symptoms.

7. Valve Dysfunction Stenosis
– All valves have some inherent restrictions. Some more than others. (see charts). We need to calculate peak and mean gradients (mitral or tricuspid pressure ½ time) as well as Effective Orifice Area (EOA)

8. Valve Dysfunction Regurgitation
– All valve have some trace of regurgitation as the
valve closes. (bioprosthetics more so).
Paravalvular
– Leaking due to a disruption in the sewing ring.
This leaking is not central but to the side of the
valve

9. Valve Dysfunction

10. Valve Dysfunction Hemolysis
– Shear stress or damage of RBC and platelets
Endocarditis
– Bacterial endocarditis can involve a bioprosthetic
valve and compromise valve function. Important
to determine presence of thrombi or vegetations

11. Valve Dysfunction Poppet/cage Variance
– Changes in the silastic disc or poppet due to
abrasion and deposits of blood lipid, can cause
stress, cracking, tearing or grooving of the
Prosthesis
– Can lead to incompetence or malfunction

12. Valve Dysfunction Valve bed abnormalities – Pseudoaneurysm
– Ring abscess

13. Valve Dysfunction Pannis ingrowth around valve
– Newly formed vascular tissue around prosthetic
valve. May impair disc or ball excursion or closure causing regurgitation, stenosis or both

14. Valve Dysfunction Dehiscence
– Refers to the rupture of one or more structures
that anchor the sewing ring of the prosthesis to
the native annulus
- Happens early in surgery or with abscess yielding
paravalvular regurgitation

15. Valve Dysfunction Calcific changes
– Occurs and progressively thickens and reduces
mobility of leaflets

16. Valve Dysfunction

17. Valve Dysfunction Fenestration (small holes)
Due to chemical treatment of bioprosthetic causing flail leaflets, rupture of valve leaflets. Could take 5-10 years. Significant regurgitation develops.