Assessment of normal hemodynamic profile of mechanical pulmonary prosthesis by doppler echocardiography: a prospective cross-sectional study

Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.

The Importance of International Normalized Ratio Monitoring in Patients With Mechanical Pulmonary Valve Prosthesis

Background

The most challenging risk of mechanical valves is thromboembolic events; therefore, life-long anticoagulation therapy is necessary. Anticoagulation therapy should be adjusted for each patient with serial international normalized ratio (INR) monitoring. Due to the small number of patients with a mechanical valve in the pulmonary position, we are facing a lack of information about the therapeutic range of the INR in these patients. We aimed to evaluate patients with a history of pulmonary valve replacement (PVR) who faced malfunction and compare their INR and echocardiographic data at the time of malfunction and 3 months prior.

Methods

In this cross-sectional study, 71 patients who had previously undergone PVR and presented to Shaheed Rajaie Cardiovascular Medical and Research Center with a diagnosis of pulmonary valve malfunction between 2014 and 2021 were included. Patients' INR and echocardiographic data at the time of the malfunction and 3 months before the malfunction diagnosis were gathered from the hospital's registry. IBM SPSS 20.0 was used for data analysis.

Results

In this cross-sectional study, 71 patients with mechanical pulmonary valve malfunction were included. 49.3% (n = 35) were men, 50.7% (n=36) were women, and their mean age was 33.23 (±8.279). The mean INR of all patients 3 months before malfunction and at the time of malfunction was 2.29 (±0.753) and 2.20 (±0.704), respectively.

Conclusion

In this study, most of our patients had an INR below the therapeutic range, both at the time of malfunction and 3 months prior. It emphasizes the importance of patient follow-up and keeping the INR in the therapeutic range.

Impact of pulmonary valve replacement on left and right ventricular function using strain analysis, in children with repaired tetralogy of Fallot

BACKGROUND

In repaired Tetralogy of Fallot (rTOF), pulmonary regurgitation and resulting right ventricular (RV) and left ventricular (LV) dysfunction are associated with adverse clinical outcomes. We performed an echocardiographic assessment of LV and RV function using Global Longitudinal Strain (GLS) and conventional echo method prior to and following Pulmonary Valvular Replacement (PVR) to help inform proper timing of operation.

RESULTS

A total of 30 rTOF patients (12.17 ± 2.5 years, 70% male) were included. Regarding to LV function, the study revealed a significant reverse correlation between LV GLS (absolute value) and early (mean = 10.4 days) and late (mean = 7.4 months) postop LVEF. Paired T-Test showed significant difference between GLS of LV and RV before and late after operation (op), however, without significant changes early postop. Late postop significant improvements occurred in other conventional echo indices of LV and RV function as well. There was also a significant correlation between echo-measured LVEF & Fraction Area Change (RV FAC) and MRI-derived LVEF & RVEF, respectively.

CONCLUSION

In this cross-sectional study in rTOF patients, RV and LV GLS as well as conventional echocardiographic indices regarding LV and RV function improved significantly after 6 months (mean = 7.4mo) following PVR.