Lecture 1: Prosthethis-patient mismatch, stenosis/obstruction, regurgitation

Week 11: lecture 1

Define Prosthesis-patient mismatch (PPM)?

When was PPM first defined?

First defined in 1978 by Dr Rahimtoola

How is PPM identified?

What is PPM also associated with?

How is PPM differentiated from PrV stenosis?

What happens to the echo parameters in PPM?

What causes prosthetic valve stenosis in bioprosthetic valve vs mechanical valves?

What can fluoroscopy be used for?

Used to show degree of valve opening

What is CFI evidence of obstruction?

Turbulent flow across the valve

What is Spectral Doppler evidence of obstruction?

What does a DPI < 0.25 in AVR suggest?

Stenosis

What happens to the AVR velocity contour and AT in severe stenosis?

What does a DVI < 2.2 in MVR suggest?

Stenosis - however, this may also be elevated when there is significant MR

Can you calculate MVA using PHT?

You cannot calculate MVA via PHT in MVR

This will overestimate MVA

What parameters suggest TVR stenosis?

When can elevated gradients be present in the absence of stenosis?

What complications can cause transvalvulvar or paravalvular regurgitation?

How is paravalvular AR graded?

What clues are suggestive of MVR MR?

+peak E velocity > 1.9m/s

+PHT <130ms

What are quantitative vs qualitative parameters that can be used to assess prosthetic valves?