Prosthetic Valve Dysfunction

Prosthetic Valve Dysfunction It is important that each patient who is to be examined either by cath or echo be questioned about pertinent medical history, symptoms and current medications. Usually this information is in the patient’s chart. Identification cards are usually issued to a patent indicating the type of valve and diameter and size, this is important for comparison

Prosthetic Valve Dysfunction – Mechanical failure: Any problem with the prosthetic valve structure either mechanical or bioprosthetic such as ball or disc 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 blood clotting)

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 the valve closes. (bioprosthetics more so). Paravalvular – Leaking due to a disruption in the sewing ring. This leaking is not central but to the side of the valve

Valve Dysfunction

Valve Dysfunction Hemolysis – Shear stress or damage of RBC and platelets Endocarditis – Bacterial endocarditis can involve a bioprosthetic valve and compromise valve function. Important to determine presence of thrombi or vegetations

Valve Dysfunction Poppet/cage Variance – Changes in the silastic disc or poppet due to abrasion and deposits of blood lipid, can cause stress, cracking, tearing or grooving of the Prosthesis – 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 prosthetic valve. May impair disc or ball excursion or closure causing regurgitation, stenosis or both

Valve Dysfunction Dehiscence – Refers to the rupture of one or more structures that anchor the sewing ring of the prosthesis to the native annulus - Happens early in surgery or with abscess yielding paravalvular regurgitation

Valve Dysfunction Calcific changes – Occurs and progressively thickens and reduces mobility 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.