Transcript Slide 1 - Atorvaacademics.com

Prosthetic
Valve
Dysfunction
Prosthetic Valve Dysfunction
It is important that each patient who is to be
examined either by cath or echo be questioned
about pertinent medical history, symptoms and
current medications.
Usually this information is in the patient’s chart.
Identification cards are usually issued to a
patent indicating the type of valve and
diameter and size, this is important for
comparison
Prosthetic Valve Dysfunction
– Mechanical failure:
Any problem with the prosthetic valve structure
either mechanical or bioprosthetic such as ball or
disc variance, thrombus, pannis, endocarditis.
Prosthetic Valve Dysfunction
•Tissue degeneration
– Infective endocarditis or ring abscess
– Loose or torn structures
– Calcific changes
– Thromboembolic complications (blood stagnation,
eddies, high shear stress contribute to blood
clotting)
Valve Dysfunction
• Early postoperative study, either prior to hospital
discharge or within the first two months thereafter,
should be performed as a baseline for subsequent
comparison.
Valve Dysfunction
• Physical examination suggests valve dysfunction, on
the basis of murmurs or other findings such as
peripheral or cerebral emboli, or endocarditis,
deterioration of cardiac function, such as a new heart
failure or other significant cardiac symptoms.
Valve Dysfunction
• Stenosis
– All valves have some inherent restrictions. Some
more than others. (see charts). We need to calculate
peak and mean gradients (mitral or tricuspid pressure
½ time) as well as Effective Orifice Area (EOA)
Valve Dysfunction
• Regurgitation
– All valve have some trace of regurgitation as the
valve closes. (bioprosthetics more so).
• Paravalvular
– Leaking due to a disruption in the sewing ring.
This leaking is not central but to the side of the
valve
Valve Dysfunction
Valve Dysfunction
• Hemolysis
– Shear stress or damage of RBC and platelets
• Endocarditis
– Bacterial endocarditis can involve a bioprosthetic
valve and compromise valve function. Important
to determine presence of thrombi or vegetations
Valve Dysfunction
• Poppet/cage Variance
– Changes in the silastic disc or poppet due to
abrasion and deposits of blood lipid, can cause
stress, cracking, tearing or grooving of the
Prosthesis
– Can lead to incompetence or malfunction
Valve Dysfunction
• Valve bed abnormalities
– Pseudoaneurysm
– Ring abscess
Valve Dysfunction
• Pannis ingrowth around valve
– Newly formed vascular tissue around prosthetic
valve. May impair disc or ball excursion or closure
causing regurgitation, stenosis or both
Valve Dysfunction
• Dehiscence
– Refers to the rupture of one or more structures
that anchor the sewing ring of the prosthesis to
the native annulus
- Happens early in surgery or with abscess yielding
paravalvular regurgitation
Valve Dysfunction
• Calcific changes
– Occurs and progressively thickens and reduces
mobility of leaflets
Valve Dysfunction
Valve Dysfunction
• Fenestration (small holes)
• Due to chemical treatment of bioprosthetic causing
flail leaflets, rupture of valve leaflets. Could take 5-10
years. Significant regurgitation develops.