Mechanical

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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.

File:Video

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

  1. 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 | PubMed ID:19733789 | HubMed [1]
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