Prosthetic Aortic Valve - Evaluation of elevated peak AV velocity

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Data Acquisition

Prosthetic aortic valve evaluation

Reference Values

Prosthetic AV Stenosis
EOA (cm2) DVI
Normal ≥1.2 ≥0.30
Possible stenosis 0.8-1.2 0.25-0.30
Suggest significant stenosis <0.8 <0.25

 

Algorithm for evaluation of elevated peak prosthetic aortic jet velocity incorporating DVI, jet contour, and AT.1

Aortic prosthetic diagnosis algorithm

*PW Doppler sample too close to the valve (particularly when jet velocity by CW Doppler is ≥4 m/s). **PW Doppler sample too far (apical) from the valve (particularly when jet velocity is 3-3.9 m/s). ∅ Stenosis further substantiated by EOA derivation compared with reference values if valve type and size are known. Fluoroscopy and TEE are helpful for further assessment, particularly in bileaflet valves. AVR, Aortic valve replacement.

Formulas

\[DVI = \frac{VTI_{LVOT}}{VTI_{PrAV}}\]

\[EOA = \frac{\pi (LVOT/2)^2 \times VTI_{LVOT}}{VTI_{PrAV}} \]

\[Indexed\hspace{0.1cm}EOA = \frac{EOA}{BSA} \]

Definitions

VPrAV Velocity across prosthetic aortic valve
ATPrAV Acceleration time to peak prosthetic aortic valve velocity
VTILVOT Velocity-time integral at LVOT
LVOT Left ventricular outflow tract diameter
VTIPrAV Velocity-time integral across prosthetic aortic valve
EOA Effective Orifice Area
DVI Doppler Velocity Index
BSA Body surface area using the Mosteller formula

Reference

1. Zoghbi WA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr 2009; 22(9):994-995. Full text

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Developer & Illustrator: Sirikarn Napan, MD, FACC