Clinical InvestigationValvular Heart DiseaseComprehensive Echocardiographic Assessment of Mechanical Tricuspid Valve Prostheses Based on Early Post-Implantation Echocardiographic Studies
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)
- et al.
Doppler echocardiographic findings in normal-functioning St. Jude Medical and Bjork-Shiley mechanical prostheses in the tricuspid valve position
Am J Cardiol
(1991) - et al.
Comprehensive echocardiographic assessment of normal mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount bioprostheses early after implantation
J Am Soc Echocardiogr
(2010) - et al.
Doppler echocardiography of 240 normal Carpentier-Edwards Duraflex porcine mitral bioprostheses: a comprehensive assessment including time velocity integral ratio and prosthesis performance index
J Am Soc Echocardiogr
(2009) - et al.
Doppler echocardiography of 79 normal CarboMedics mitral prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index
J Am Soc Echocardiogr
(2007) - et al.
Doppler echocardiography of 119 normal-functioning St. Jude Medical mitral valve prostheses: a comprehensive assessment including time-velocity integral ratio and prosthesis performance index
J Am Soc Echocardiogr
(2005) - et al.
Doppler echocardiography of normal Starr-Edwards mitral prostheses: a comprehensive function assessment including continuity equation and time-velocity integral ratio
J Am Soc Echocardiogr
(2005) - et al.
J Am Soc Echocardiogr
(2009) - et al.
Validation and applications of mitral prosthetic valvular areas calculated by Doppler echocardiography
Am J Cardiol
(1990) - et al.
Hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years
Ann Thorac Surg
(2007) - et al.
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice
J Am Soc Echocardiogr
(2009)
Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function
Am J Cardiol
Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical
Ann Thorac Surg
Cited by (0)
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.