Prosthetic Valve Complications

Structure Failure

Damage to mechanics or breakdown of tissue within valve

Due to uneven stress or blood lipids

Causes valve regurgitation and malfunction

Pannus

Overgrowth of normal tissue into valve

Thrombus Formation

More common in mechanical valves

Can restrict valve movement

Thromboembolism possible

Bacterial Endocarditis in Mechanical Valves

Perivalvular origin at annulus interface

Leads to ring of bases and dehiscence

Bacterial Endocarditis in Bioprosthetic Valves

Cusp origin

Leads to abscesses, pseudoaneurysms, fistulas

Sonographic appearance of Bacterial Endocarditis

Thickened leaflets

Vegetations on leaflets or chamber walls

Leaflet deterioration = regurgitation

Paravalvular Leak

Leak around valve annulus - not the same as regurgitant jet

Dehiscence

Valve ring disconnects from wall

Rocking valve on 2D and M-mode

Large paravalvular leak with severe regurgitation

Poor prognosis if not treated

Abscess Formation on Valve Ring

Fistula

Due to abscess formation

Common places to find fistulas

Between LV & RA

Between LV & left coronary artery

Between LA & aorta

Wall Aneurysm

Weakening of wall due to abnormal attachment of prosthetic valve

Pseudoaneurysm at Valve Attachment Site

More common with disk valves

Cystic area with neck near valve annulus

Causes of decreased cardiac output with prosthetic valves

Increased stress from paravalvular leaks or dehiscence

Arrhythmia

Size mismatch of prosthetic valve