Mechanical
Mechanical prosthetic valves
| 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 |
| 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
- Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA Jr, Nakatani S, Quiñones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M, American Society of Echocardiography's Guidelines and Standards Committee, Task Force on Prosthetic Valves, American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, Canadian Society of Echocardiography, American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, and Canadian Society of Echocardiography. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009 Sep;22(9):975-1014; quiz 1082-4. DOI:10.1016/j.echo.2009.07.013 |