Chad M. House1,2,4, Katie A. Moriarty1,2,3, William B. Nelson1,2,31Regions Hospital Heart Center, St. Paul, MN, USA,
2HealthPartners Medical Group, Bloomington, MN, USA
3University of Minnesota Medical School, Minneapolis, MN, USA
4Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: The study aim was to determine the prevalence of normally functioning mitral prostheses with mean gradient ≥10 mmHg, and to identify the characteristics and echocardiographic variables that might be useful to distinguish normal function from dysfunction.
Methods: A total of 56 consecutive patients with a prosthetic mitral valve and mean gradient ≥10 mmHg was retrospectively identified. Nineteen patients without subsequent imaging confirming normal prosthesis function or dysfunction were excluded; hence, 37 patients were classified as obstruction, insufficiency, or normal prosthesis (high-gradient; NPHG). A comparison group of 25 patients with a mean transprosthetic gradient of ≤5 mmHg (low-gradient group) was also identified.
Results: Of the 37 patients, seven (19%) had obstruction, 10 (27%) had significant valvular or perivalvular
insufficiency, and 20 (54%) were deemed NPHG. NPHG patients had a similar net atrioventricular compliance (Cn) to those with obstruction and insufficiency, which was significantly lower than the low-gradient group. The cardiac index (CI) was significantly higher in the NPHG group (3.4 ± 0.9 l/min/m2) compared to all other groups (p = 0.001). Receiver operator characteristic curves showed that the indexed effective orifice area (EOAi), effective orifice area (EOA) and velocity-time integral ratio distinguished NPHG from abnormal prosthesis function in patients with mean gradients ≥10 mmHg (area under curve = 0.92, 0.86, and 0.82, respectively).
Conclusion: The study data suggested that a plurality of individuals with a mean transprosthetic mitral gradient ≥10 mmHg will be found to have a normally functioning prosthesis. Most of these patients will have a small EOAi, a reduced Cn, and a relatively increased CI.
The Journal of Heart Valve Disease 2017;26:667-676
|Prevalence and Doppler Echocardiographic Characteristics of Normally Functioning Mitral Prostheses with Mean Gradient ≥10 mmHg|
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