How does Doppler-estimated effective prosthetic valve orifice area compare to in vitro maker-declared area in patients after aortic valve replacement?
Doppler-estimated effective prosthetic valve areas in patients are significantly smaller than maker-declared in vitro areas, and are influenced by prosthesis type, size, and patient gender.
Doppler echocardiography was performed on 108 patients 4-15 days after implantation of a Medtronic-Hall, Biocor or Carpentier-Edwards S.A.V. prosthetic aortic valve because of aortic stenosis. Significant correlation was found between the in vitro (maker-declared) and the Doppler-estimated effective prosthetic valve orifice area (r = 0.70, p < 0.01). Doppler-estimated prosthetic valve orifice area, but not transprosthetic blood velocities, discriminated between different sizes of Medtronic-Hall and Biocor valves. The effective orifice area in these valves was 57% of the in vitro area, but in Carpentier-Edwards valves it was only 43%. Transprosthetic blood velocity was inversely related to orifice area in men, but not in women, who also had longer duration of systole and better preservation of systolic left ventricular function. The data suggest that the effective prosthetic valve areas found in patients are significantly smaller than the experimental in vitro areas. Prosthesis size and type, anatomic and hemodynamic variables and gender are important in Doppler estimation of effective valve area.
Gerdts et al. (Sat,) studied this question.
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