Elevated prosthetic valve gradients

Elevated prosthetic valve gradients Elevated gradients across prosthetic valves can occur due to various reasons. But before declaring that prosthetic valve gradients are elevated, the usual gradient across the given type of prosthetic valve should be known. Different types of normally functioning prosthetic heart valves have different gradients. Normal gradient is different between the various valve positions. Transmitral prosthetic valve gradient is lower than transaortic prosthetic valve gradient. If the gradient during post operative review is available, it can be used as a benchmark for comparison. Some of the important causes for elevated prosthetic valve gradients are prosthetic valve thrombus, pannus, large vegetations, calcific degeneration of bioprosthetic valve, patient prosthesis mismatch, high output state, pressure recovery phenomenon and high velocity central flow in a bileaflet valve [1]. Clinical scenario should be considered in detail during evaluation of elevated gradients as echocardiographic patterns have their own limitations in the assessment of prosthetic valves. Body surface area should be checked while assessing patient prosthesis mismatch. Elevated transprosthetic gradient is an important feature of thrombus within the prosthetic valve [2]. In the mitral position, a gradient >8 mm Hg is suggestive of prosthetic valve thrombosis. In case of aortic prosthetic valve, the suggested cut off value is >45 mm Hg [2]. A word of caution is needed here ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Echocardiography Source Type: blogs