Clinical Investigation
Valvular Heart Disease
Comprehensive Echocardiographic Assessment of Mechanical Tricuspid Valve Prostheses Based on Early Post-Implantation Echocardiographic Studies

https://doi.org/10.1016/j.echo.2010.12.021Get rights and content

Background

Doppler-derived hemodynamic data for normal tricuspid mechanical valve prostheses are limited.

Methods

A comprehensive retrospective Doppler echocardiographic assessment of 78 normal St. Jude Medical Standard (St. Jude Medical, Inc., St. Paul, MN), CarboMedics Standard (CarboMedics, Inc., Sorin Group, Burnaby, British Columbia, Canada), and Starr-Edwards (Edwards Lifesciences, LLC, Irvine, CA) mechanical tricuspid valve prostheses was performed early after implantation. We used all the important Doppler-derived hemodynamic variables reported to date, including peak early diastolic velocity (E velocity), mean gradient, pressure half-time, time velocity integral of the tricuspid valve prosthesis (TVITVP), and ratio of the time velocity integral of the tricuspid valve prosthesis to the time velocity integral of the left ventricular outflow tract (TVITVP/TVILVOT).

Results

The mean values obtained for the Doppler parameters did not differ significantly when the measurements from five or nine consecutive cardiac cycles were averaged. Pressure half-time was <130 msec in all 43 patients with St. Jude Medical Standard and CardioMedics Standard prostheses in whom it could be measured. Mean gradient <6 mm Hg, E velocity <1.9 m/s, TVITVP <46 cm, and TVITVP/TVILVOT <2.1 were recorded in 59 (87%) of the 68 patients with either of these prostheses. Hemodynamic variables were considerably less favorable in patients with Starr-Edwards prostheses.

Conclusion

These calculated threshold values (mean + 2 SD) are useful for identifying normal tricuspid mechanical valve function. Prostheses with values for hemodynamic variables that are outside the mean + 2 SD parameters that we have calculated are most likely to be dysfunctional. However, in rare cases, mechanical tricuspid valve prostheses may be dysfunctional even when their hemodynamic parameters are within these specified ranges because of small body surface area or other factors.

Section snippets

Materials and Methods

The study was approved by the Mayo Clinic Institutional Review Board. All study patients provided written informed consent to allow the use of their medical records for research purposes. No industry support was provided.

Clinical Characteristics

Characteristics of the 78 patients who had mechanical tricuspid valve prostheses implanted are summarized in Table 1, Table 2, Table 3. The most common indications for tricuspid valve replacement were nonrheumatic tricuspid regurgitation in 24 patients (31%), rheumatic heart disease in 16 patients (21%), carcinoid heart disease in 10 patients (13%), and unrepairable Ebstein anomaly in 8 patients (10%). A standard mechanical prosthesis was implanted in all patients, 64 (82%) of whom had TTE

Number of Cardiac Cycles

Doppler measurements of tricuspid prostheses have been found to demonstrate beat-to-beat differences because of respiration, even with regular heart rhythm. Connolly et al.6 recommended averaging 10 consecutive cardiac cycles when evaluating tricuspid prosthesis function. Although some patients in the current study had substantial beat-to-beat variability in Doppler measurements, there was no significant difference overall, regardless of whether five or nine consecutive cycles were averaged.

Conclusions

Ascertaining normal cardiac prosthesis valve function remains a challenge. Our intent in this study was to provide in vivo data on a large number of normal SJM, CM, and SE mechanical tricuspid valve prostheses, including all the important Doppler variables. These findings can be used in the early postoperative assessment of patients with these types of mechanical tricuspid valve prostheses. Further evaluation, including TEE, should be considered for patients with outlier data that indicate

Acknowledgments

The authors thank Judy Lenoch and Barbara Manahan for assistance in collecting and analyzing data for this article.

References (25)

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Research funding was provided by the Division of Cardiovascular Diseases, Mayo Clinic.

Conflict of interest: none.

Portions of this manuscript have been published in J Am Soc Echocardiogr 2007;20:1125-30.

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