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Education in Heart
Valvular heart disease
Doppler echocardiographic evaluation of prosthetic valve function
  1. Philippe Pibarot1,
  2. Jean G Dumesnil2
  1. 1Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Québec, Canada
  2. 2Department of Medicine, Laval University, Québec, Canada
  1. Correspondence to Dr Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec G1V-4G5, Canada; philippe.pibarot{at}med.ulaval.ca

https://doi.org/10.1136/heartjnl-2011-300351

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    Owing to its versatile, non-invasive, radiation-free, and low cost nature, Doppler echocardiography is undoubtedly the method of choice to evaluate prosthetic valve function. This evaluation follows the same principles used for the evaluation of native valves, with some important specifics and caveats described in this article. A complete echocardiography includes two dimensional imaging of the prosthetic valve, evaluation of valve leaflet/occluder morphology and mobility, measurement of the transprosthetic gradients and valve effective orifice area (EOA), estimation of the degree of regurgitation, evaluation of left ventricular size and systolic function, and calculation of systolic pulmonary arterial pressure.1

    Timing of echocardiographic follow-up

    Ideally, a baseline postoperative transthoracic echocardiography (TTE) study should be performed 3–12 weeks after surgery, when the chest wound has healed, ventricular function has improved, and anaemia with its associated hyperdynamic state has resolved.1 w1 w2 However, if the patient is being transferred and/or may not return, it may be best to perform the study before hospital discharge, although image quality and reliability of measurements are often suboptimal. Annual echocardiography is recommended in patients with bioprosthetic valves after the first 5 years, whereas in patients with mechanical valves, routine annual echocardiography is not indicated in the absence of a change in clinical status.1 w1 w2

    Detection and quantification of prosthetic valve stenosis

    The appearance of a new murmur or symptom in a patient with a prosthetic valve should prompt an urgent TTE study and, if indicated, transoesophageal echocardiography (TOE). However, the initial suspicion of prosthetic valve stenosis may be the incidental finding of abnormally …

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    Footnotes

    • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. Dr Pibarot has received research grants from Edwards Life Sciences, Medtronic Inc, and Sorin Medical. Dr Dumesnil has no conflict of interest with regard to this work.

    • Provenance and peer review Commissioned; internally peer reviewed.