Mechanical

Mechanical prosthetic valves

Normal Values Mechanical Aortic Valve Art[1]

Valve	Type	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	EOA (cm2)
ATS	Bileaflet	19	47.0 ± 12.6	25.3 ± 8	1.1 ± 0.3
		21	23.7 ± 6.8	15.9 ± 5.0	1.4 ± 0.5
		23		14.4 ± 4.9	1.7 ± 0.5
		25		11.3 ± 3.7	2.1 ± 0.7
		27		8.4 ± 3.7	2.5 ± 0.1
		29		8.0 ± 3.0	3.1 ± 0.8
		18		21.0 ± 1.8	1.2 ± 0.3
		20	21.4 ± 4.2	11.1 ± 3.5	1.3 ± 0.3
		22	18.7 ± 8.3	10.5 ± 4.5	1.7 ± 0.4
		24	15.1 ± 5.6	7.5 ± 3.1	2.0 ± 0.6
		26		6.0 ± 2.0	2.1 ± 0.4
Bjork-Shiley	Single tilting disc	21	38.9 ± 11.9	21.8 ± 3.4	1.1 ± 0.3
		23	28.8 ± 11.2	15.7 ± 5.3	1.3 ± 0.3
		25	23.7 ± 8.2	13.0 ± 5.0	1.5 ± 0.4
		27		10.0 ± 2.0	1.6 ± 0.3
Carbomedics Reduced	Bileaflet	19	43.4 ± 1.2	24.4 ± 1.2	1.2 ± 0.1
Carbomedics Standard	Bileaflet	19	38.0 ± 12.8	18.9 ± 8.3	1.0 ± 0.3
		21	26.8 ± 10.1	12.9 ± 5.4	1.5 ± 0.4
		23	22.5 ± 7.4	11.0 ± 4.6	1.4 ± 0.3
		25	19.6 ± 7.8	9.1 ± 3.5	1.8 ± 0.4
		27	17.5 ± 7.1	7.9 ± 3.2	2.2 ± 0.2
		29	9.1 ± 4.7	5.6 ± 3.0	3.2 ± 1.6
Carbomedics Tophat	Bileaflet	21	30.2 ± 10.9	14.9 ± 5.4	1.2 ± 0.3
		23	24.2 ± 7.6	12.5 ± 4.4	1.4 ± 0.4
		25		9.5 ± 2.9	1.6 ± 0.32
Edwards Duromedics	Bileaflet	21	39.0 ± 13
		23	32.0 ± 8.0
		25	26.0 ± 10.0
		27	24.0 ± 10.0
Edwards Mira	Bileaflet	19		18.2 ± 5.3	1.2 ± 0.4
		21		13.3 ± 4.3	1.6 ± 0.4
		23		14.7 ± 2.8	1.6 ± 0.6
		25		13.1 ± 3.8	1.9
MCRI On-X	Bileaflet	19	21.3 ± 10.8	11.8 ± 3.4	1.5 ± 0.2
		21	16.4 ± 5.9	9.9 ± 3.6	1.7 ± 0.4
		23	15.9 ± 6.4	8.6 ± 3.4	1.9 ± 0.6
		25	16.5 ± 10.2	6.9 ± 4.3	2.4 ± 0.6
Medtronic Advantage	Bileaflet	23		10.4 ± 3.1	2.2 ± 0.3
		25		9.0 ± 3.7	2.8 ± 0.6
		27		7.6 ± 3.6	3.3 ± 0.7
		29		6.1 ± 3.8	3.9 ±0.7
Medtronic Hall	Single tilting disc	20	34.4 ± 13.1	17.1 ± 5.3	1.2 ± 0.5
		21	26.9 ± 10.5	14.1 ± 5.9	1.1 ± 0.2
		23	26.9 ± 8.9	13.5 ± 4.8	1.4 ± 0.4
		25	17.1 ± 7.0	9.5 ± 4.3	1.5 ± 0.5
		27	18.9 ± 9.7	8.7 ± 5.6	1.9 ± 0.2
Monostrut Bjork-Shiley	Single tilting disc	19		27.4 ± 8.8
		21	27.5 ± 3.1	20.5 ± 6.2
		23	20.3 ± 0.7	17.4 ± 6.4
		25		16.1 ± 4.9
		27		11.4 ± 3.8
Omnicarbon	Single tilting disc	21	37.4 ± 12.8	20.4 ± 5.4	1.3 ± 0.5
		23	28.8 ± 9.1	17.4 ± 4.9	1.5 ± 0.3
		25	23.7 ± 8.1	13.2 ± 4.6	1.9 ± 0.5
		27	20.1 ± 4.2	12.4 ± 2.9	2.1 ± 0.4
Omniscience	Single tilting disc	21	50.8 ± 2.8	28.2 ± 2.2	0.9 ± 0.1
		23	39.8 ± 8.7	20.1 ± 5.1	1.0 ± 0.1
Sorin Bicarbon	Bileaflet	19	30.1 ± 4.5	16.7 ± 2.0	1.4 ± 0.1
		21	22.0 ± 7.1	10.0 ± 3.3	1.2 ± 0.4
		23	16.8 ± 6.1	7.7 ± 3.3	1.5 ± 0.2
		25	11.2 ± 3.1	5.6 ± 1.6	2.4 ± 0.3
St. Jude Medical Haem Plus	Bileaflet	19	28.5 ± 10.7	17.0 ± 7.8	1.9 ± 0.1
		21	16.3 ± 17.0	10.6 ± 5.1	1.8 ± 0.5
		23	16.8 ± 7.3	12.1 ± 4.2	1.7 ± 0.5
St. Jude Medical Regent	Bileaflet	19	20.6 ± 12	11.0 ± 4.9	1.6 ± 0.4
		21	15.6 ± 9.4	8.0 ± 4.8	2.0 ± 0.7
		23	12.8 ± 6.8	6.9 ± 3.5	2.3 ± 0.9
		25	11.7 ± 6.8	5.6 ± 3.2	2.5 ± 0.8
		27	7.9 ± 5.5	3.5 ± 1.7	3.6 ± 0.5
St. Jude Medical Standard	Bileaflet	19	42.0 ± 10.0	24.5 ± 5.8	1.5 ± 0.1
		21	25.7 ± 9.5	15.2 ± 5.0	1.4 ± 0.4
		23	21.8 ± 7.5	13.4 ± 5.6	1.6 ± 0.4
		25	18.9 ± 7.3	11.0 ± 5.3	1.9 ± 0.5
		27	13.7 ± 4.2	8.4 ± 3.4	2.5 ± 0.4
		29	13.5 ± 5.8	7.0 ± 1.7	2.8 ± 0.5
Starr Edwards	Caged ball	23	32.6 ± 12.8	22.0 ± 9.0	1.1 ± 0.2
		24	34.1 ± 10.3	22.1 ± 7.5	1.1 ± 0.3
		26	31.8 ± 9.0	19.7 ± 6.1
		27	30.8 ± 6.3	18.5 ± 3.7
		29	29.0 ± 9.3	16.3 ± 5.5

Normal Values Mechanical Mitral valve art[1]

Valve	Type	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	Peak Velocity (m/s)	Pressure half-time (ms)	EOA (cm2)
Bjork-Shiley	Tilting disc	23			1.7	115
		25	12 ± 4	6 ± 2	1.75 ± 0.38	99 ± 27	1.72 ± 0.6
		27	10 ± 4	5 ± 2	1.6 ± 0.49	89 ± 28	1.81 ± 0.54
		29	7.83 ± 2.93	2.83 ± 1.27	1.37 ± 0.25	79 ± 17	2.1 ± 0.43
		31	6 ± 3	2 ± 1.9	1.41 ± 0.26	70 ± 14	2.2 ± 0.3
Bjork-Shiley monostrut	Tilting disc	23		5.0	1.9
		25	13 ± 2.5	5.57 ± 2.3	1.8 ± 0.3
		27	12 ± 2.5	4.53 ± 2.2	1.7 ± 0.4
		29	13 ± 3	4.26 ± 1.6	1.6 ± 0.3
		31	14 ± 4.5	4.9 ± 1.6	1.7 ± 0.3
Carbomedics	Bileaflet	23			1.9 ± 0.1	126 ± 7
		25	10.3 ± 2.3	3.6 ± 0.6	1.3 ± 0.1	93 ± 8	2.9 ± 0.8
		27	8.79 ± 3.46	3.46 ± 1.03	1.61 ± 0.3	89 ± 20	2.9 ± 0.75
		29	8.78 ± 2.9	3.39 ± 0.97	1.52 ± 0.3	88 ± 17	2.3 ± 0.4
		31	8.87 ± 2.34	3.32 ± 0.87	1.61 ± 0.29	92 ± 24	2.8 ± 1.14
		33	8.8 ± 2.2	4.8 ± 2.5	1.5 ± 0.2	93 ± 12
Duromedics	Bileaflet	27	13 ± 6	5 ± 3	1.61 ± 0.4	75 ± 12
		29	10 ± 4	3 ± 1	1.40 ± 0.25	85 ± 22
		31	10.5 ± 4.33	3.3 ± 1.36	1.38 ± 0.27	81 ± 12
		33	11.2	2.5		85
Lillehei-Kaster	Tilting disc	18			1.7	140
		20			1.7	67
		22			1.56 ± 0.09	94 ± 22
		25			1.38 ± 0.27	124 ± 46
Medtronic Hall	Tilting disc	27			1.4	78
		29			1.57 ± 0.1	69 ± 15
		31			1.45 ± 0.12	77 ± 17
Omnicarbon	Tilting disc	23		8.0
		25		6.05 ± 1.81	1.77 ± 0.24	102 ± 16
		27		4.89 ± 2.05	1.63 ± 0.36	105 ± 33
		29		4.93 ± 2.16	1.56 ± 0.27	120 ± 40
		31		4.18 ± 1.4	1.3 ± 0.23	134 ± 31
		33		4 ± 2
On-X	Bileaflet	25	11.5 ± 3.2	5.3 ± 2.1			1.9 ± 1.1
		27	10.3 ± 4.5	4.5 ± 1.6			2.2 ± 0.5
		29	10.3 ± 4.5	4.5 ± 1.6			2.2 ± 0.5
		31	9.8 ± 3.8	4.8 ± 2.4			2.5 ± 1.1
		33	9.8 ± 3.8	4.8 ± 2.4			2.5 ± 1.1
Sorin Allcarbon	Tilting disc	25	15 ± 0.25	4 ± 0.5	1.95 ± 0.02	70 ± 1
		27	11 ± 2.75	4 ± 0.5	1.65 ± 0.21	82 ± 20
		29	12 ± 3	4 ± 1.25	1.73 ± 0.22	80 ± 14
		31	10 ± 1.5	4 ± 1	1.66 ± 0.11	83 ± 14
St. Jude Medical	Bileaflet	23		4.0	1.5	160	1.0
		25		2.5 ± 1	1.34 ± 1.12	75 ± 4	1.35 ± 0.17
		27	11 ± 4	5 ± 1.82	1.61 ± 0.29	75 ± 10	1.67 ± 0.17
		29	10 ± 3	4.15 ± 1.8	1.57 ± 0.29	85 ± 10	1.75 ± 0.24
		31	12 ± 6	4.46 ± 2.22	1.59 ± 0.33	74 ± 13	2.03 ± 0.32
Starr-Edwards	Caged ball	26		10.0			1.4
		28		7 ± 2.75			1.9 ± 0.57
		30	12.2 ± 4.6	6.99 ± 2.5	1.7 ± 0.3	125 ± 25	1.65 ± 0.4
		32	11.5 ± 4.2	5.08 ± 2.5	1.7 ± 0.3	110 ± 25	1.98 ± 0.4
		34		5.0			2.6

Leakage

There is slight insufficiency, in all of the mechanical prosthetic valves it is the flow that is needed to allow the valve can be closed and keep the valve free from clots. This flow is due to the hinges of the valve. The degree of leakage and lekpatroon is by design prosthetic valve depends. At a St Jude can sometimes five small flames are observed. TEE This leakage is generally low.

Mitral regurgitation with prosthetic valve

Hemodynamically significant (at least moderate) mitral regurgitation with prosthetic valves without obstruction. ( PHT <120 msec)

Peak inflow velocity > 1.9 m/s (CW - Doppler)

Peakgradiënt > 14 mmHg (CW - Doppler)

TVI MV inflow (CW - Doppler/TVI LVOT (PW Doppler) > 2.5

These measurements can help you on the spot. Alert pathological mitraliskunstklep leakage after further research is needed with TEE.

Related valve dysfunction with mechanical prostheses

Bjork- Shiley: strut fracture

Carbomedics: degeneration disc

Hancock bioprosthesis: Distortion stents causing stenosis

Carpentier Edwards bioprosthesis: tear/holes in leaflets and development of stenosis

References

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