MedStar Authors catalog › Details for: Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. [Review]
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Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. [Review]

by Thourani, Vinod H.
Citation: Jacc: Cardiovascular Imaging. 12(1):149-162, 2019 01..Journal: JACC. Cardiovascular imaging.Published: 2019; ISSN: 1876-7591.Full author list: Blanke P; Cote N; Hahn R; Leipsic J; Magne J; Pibarot P; Thourani VH.UI/PMID: 30621987.Subject(s): *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Bioprosthesis | *Echocardiography | *Heart Valve Prosthesis | *Multidetector Computed Tomography | *Postoperative Complications/dg [Diagnostic Imaging] | *Prosthesis Implantation/is [Instrumentation] | *Transcatheter Aortic Valve Replacement/is [Instrumentation] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Echocardiography, Doppler, Color | Echocardiography, Doppler, Pulsed | Echocardiography, Transesophageal | Hemodynamics | Humans | Multimodal Imaging | Postoperative Complications/et [Etiology] | Postoperative Complications/pp [Physiopathology] | Predictive Value of Tests | Prosthesis Design | Prosthesis Implantation/ae [Adverse Effects] | Risk Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, Non-U.S. Gov't | ReviewOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: JACC Cardiovasc Imaging. 12(1):149-162, 2019 01.Abstract: Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient's body size, thus resulting in high residual postoperative pressure gradients across the prosthesis. Severe PPM occurs in 2% to 20% of patients undergoing surgical aortic valve replacement (AVR) and is associated with 1.5- to 2.0-fold increase in the risk of mortality and heart failure rehospitalization. The purpose of this article is to present an overview of the role of multimodality imaging in the assessment, prediction, prevention, and management of PPM following AVR. The risk of PPM can be anticipated at the time of AVR by calculating the predicted indexed from the normal reference value of EOA of the selected prosthesis and patient's body surface area. The strategies to prevent PPM at the time of surgical AVR include: 1) implanting a newer generation of prosthetic valve with better hemodynamic; 2) enlarging the aortic root or annulus to accommodate a larger prosthetic valve; or 3) performing TAVR rather than surgical AVR. The identification and quantitation of PPM as well as its distinction versus prosthetic valve stenosis is primarily based on transthoracic echocardiography, but important information may be obtained from other imaging modalities such as transesophageal echocardiography and multidetector computed tomography. PPM is characterized by high transprosthetic velocity and gradients, normal EOA, small indexed EOA, and normal leaflet morphology and mobility. Transesophageal echocardiography and multidetector computed tomography are particularly helpful to assess prosthetic valve leaflet morphology and mobility, which is a cornerstone of the differential diagnosis between PPM and pathologic valve obstruction. Severe symptomatic PPM following AVR with a bioprosthetic valve may be treated by redo surgery or the transcatheter valve-in-valve procedure with fracturing of the surgical valve stent. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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