Usefulness of the Doppler velocity index in the evaluation of prosthetic pulmonary valves

Introduction The Doppler velocity index (DVI) is a non-invasive diagnostic tool that has demonstrated its utility in evaluating valve prosthetics in other cardiac positions. However, its specific application in assessing pulmonary valve prosthetics remains under-researched. Main Objective: This study aims to explore the utility of the DVI in the evaluation of pulmonary valve prosthetics. Materials and Methods A descriptive, observational, and retrospective study was conducted, including patients who had undergone surgery for the placement of prosthetic valves in the pulmonary position. The population consisted of patients aged 15 years and older, of both sexes. The sample was non-probabilistic and included patients with mechanical or biological pulmonary valve replacements, whether performed surgically or percutaneously. The parameters for evaluating the pulmonary valve prosthetics included Doppler evaluation (velocities, gradients, Doppler velocity index: TVI RVOT/TVI PV and TVI LVOT/ TVI PV, acceleration time, and EOA). Statistical analysis was conducted for comparison between groups according to the function of the prosthesis, with the aim of identifying significant differences among them. A p-value of <0.05 was considered statistically significant in all analyses. The Kruskal-Wallis test and ANOVA with Bonferroni post hoc analysis were used for group comparisons. Results Data were collected from 75 patients with pulmonary valve replacement, of whom 97.3% had biological prostheses and 2.6% had mechanical prostheses. Regarding the total population, an average age of 28 years (ranging from 21 to 38) was observed, comprising 60% women and 40% men. The most frequent diagnosis was Tetralogy of Fallot (38.6%). In terms of prostheses, the vast majority were biological prostheses, with the most commonly used being the Carpentier Edwards (39.4%). Notably, the echocardiographic data collected indicated that right ventricular function was normal in the large majority of the recruited patients, with a mean TAPSE of 17.7 mm ± 3.7 and S' wave velocity of 9.5 cm/s ± 2.3. The values obtained for determining dysfunction were <0.34 for the right ventricular outflow tract (RVOT) and <0.35 for the left ventricular outflow tract (LVOT). The average DVI for normofunctional prostheses was 0.48 (0.34-0.6) with RVOT and 0.43 (0.35-0.56) with LVOT. In the analysis of variance to determine the correlation of the DVI with the functionality of the prosthesis, a statistical difference was found in the stenosis and mixed groups compared to the normofunctional and regurgitation groups. Statistical significance was greater with the DVI calculated using the velocity-time integral of the LVOT. Conclusions The Doppler velocity index is a valuable tool for determining the functionality of pulmonary valve prosthetics. Its application may enhance diagnostic accuracy and guide clinical decision-making in patients with prosthetic valves.