Prosthetic Valve

Dysfunction

Usually this information is in the patient’s chart.Identification cards are usually issued to apatent indicating the type of valve anddiameter and size, this is important forcomparison

Prosthetic Valve Dysfunction

It is important that each patient who is to beexamined either by cath or echo be questioned about pertinent medical history, symptoms and current medications.

– Mechanical failure:Any problem with the prosthetic valve structureeither mechanical or bioprosthetic such as ball ordisc variance, thrombus, pannis, endocarditis.

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 bloodclotting)

Prosthetic 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.

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.

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)

Valve Dysfunction

• Regurgitation– All valve have some trace of regurgitation as thevalve closes. (bioprosthetics more so).

• Paravalvular– Leaking due to a disruption in the sewing ring.This leaking is not central but to the side of thevalve

Valve Dysfunction

Valve Dysfunction

• Hemolysis– Shear stress or damage of RBC and platelets

• Endocarditis– Bacterial endocarditis can involve a bioprostheticvalve and compromise valve function. Importantto determine presence of thrombi or vegetations

Valve Dysfunction

• Poppet/cage Variance

– Changes in the silastic disc or poppet due toabrasion and deposits of blood lipid, can causestress, cracking, tearing or grooving of theProsthesis

– Can lead to incompetence or malfunction

Valve Dysfunction

• Valve bed abnormalities

– Pseudoaneurysm– Ring abscess

Valve Dysfunction

• Pannis ingrowth around valve

– Newly formed vascular tissue around prostheticvalve. May impair disc or ball excursion or closure causing regurgitation, stenosis or both

Valve Dysfunction

• Dehiscence

– Refers to the rupture of one or more structuresthat anchor the sewing ring of the prosthesis tothe native annulus

- Happens early in surgery or with abscess yieldingparavalvular regurgitation

Valve Dysfunction

• Calcific changes– Occurs and progressively thickens and reducesmobility of leaflets

Valve Dysfunction

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.

Valve Dysfunction