This document provides an overview of echocardiography for evaluating prosthetic heart valves after mitral or aortic valve replacement. It discusses the different types of replacement valves and the principles of echocardiographic assessment. For post-mitral valve replacement, the document describes the echo views and Doppler findings that should be assessed to evaluate valve function and identify any obstruction. It similarly outlines the echo views and parameters to examine for prosthetic aortic valves. Finally, it reviews potential complications of prosthetic valves including dysfunction, dehiscence, thromboemboli, and endocarditis.
A heart coping with a dysfunctional prosthetic valveescardio
A heart coping with a dysfunctional prosthetic valve (at least once in every few beats…)
http://www.escardio.org/communities/Working-Groups/valvular/Pages/welcome.aspx
Evaluation of prosthetic valve function and clinical utility.Ramachandra Barik
Many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.
A heart coping with a dysfunctional prosthetic valveescardio
A heart coping with a dysfunctional prosthetic valve (at least once in every few beats…)
http://www.escardio.org/communities/Working-Groups/valvular/Pages/welcome.aspx
Evaluation of prosthetic valve function and clinical utility.Ramachandra Barik
Many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Nursing management of patient with cardiac surgeries.PrashantSalve10
It will be helpful to overview cardiac surgeries like CABG, Valvular surgeries and heart transplant. It also enumerates the nursing diagnoses and its brief description.
Transeptal access is an integral skill for interventional cardiologists for a multitude of cardiac interventions including,
balloon mitral valvotomy a commonly performed procedure
in India and south Asia. The procedure was first performed by
Braunwald, Ross and Morrow and later refined by Brockenbrough
and Mullins, whose names have been intricately
linked with this procedure.1e3 The procedure, however,
evokes considerable trepidation in many young interventionalists due its steep learning curve and potential catastrophic complications. However, the procedure is relatively
simple in most patients, barring patients with extremely distorted
anatomy like aneursymally dilated left/right atria
where the anatomy of the interatrial septum is often grossly
altered.
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
Nursing management of patient with cardiac surgeries.PrashantSalve10
It will be helpful to overview cardiac surgeries like CABG, Valvular surgeries and heart transplant. It also enumerates the nursing diagnoses and its brief description.
Transeptal access is an integral skill for interventional cardiologists for a multitude of cardiac interventions including,
balloon mitral valvotomy a commonly performed procedure
in India and south Asia. The procedure was first performed by
Braunwald, Ross and Morrow and later refined by Brockenbrough
and Mullins, whose names have been intricately
linked with this procedure.1e3 The procedure, however,
evokes considerable trepidation in many young interventionalists due its steep learning curve and potential catastrophic complications. However, the procedure is relatively
simple in most patients, barring patients with extremely distorted
anatomy like aneursymally dilated left/right atria
where the anatomy of the interatrial septum is often grossly
altered.
Veno-Arterial Ecmo (VA-ECMO) & Their basicGunalan M.M
VA ECMO stands for Venoarterial Extracorporeal Membrane Oxygenation. It's a life-saving medical procedure used in critical situations where the heart and lungs are unable to function adequately. VA ECMO involves diverting blood from the body, oxygenating it outside the body, and then returning it to the arterial system, effectively bypassing the heart and lungs. This allows time for the organs to rest and heal, supporting patients with severe cardiac or respiratory failure.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. CONTENTS:
INTRODUCTION
TYPES OF REPLACEMENT VALVES:
DESIRED VALVES
BASIC PRINCIPLES OF THE ECHOCARDIOGRAPHIC EXAMINATION OF
PROSTHETIC VALVES:
Two dimensional echocardiography
Doppler echocardiography
- Color flow mapping
3. CONTENTS:
POST MITRAL VALVE REPLACEMENT:
Echo assessment
Echo findings
Is there evidence of obstruction?
POST AORTIC VALVE REPLACEMENT:
Echo assessment
Echo findings
is there evidence of obstruction?
COMPLICATIONS OF PROSTHETIC VALVES:
Prosthetic dysfunction
REFERENCES
4. INTRODUCTION
The introduction of valve replacement surgery in the early 1960s has dramatically improved
the outcome of patients with Valvular heart disease.
By their design, almost all replacement valves are obstructive compared with normal native
valves.
Minor regurgitation through the prosthetic valve is usually normal and the pattern differs
between the types of valve.
The mechanical parts make imaging hard because of artefact and also the effects of
shielding.
Despite the improvement in prosthetic valve design and surgical procedures, valve
replacement does not provide a definitive cure.
5. TYPES OF REPLACEMENT VALVES:
Replacement valves are either MECHANICAL or BIOLOGICAL.
6. DESIRED VALVES:
The most frequently implanted biological types are those made from animal tissue,
‘xenografts’ usually made from pig aorticvalves or bovine pericardium.
The most frequently implanted mechanical valve now is the Bileafletmechanical valve but
tilting discvalves are still used.
An important new class of valve is the transcatheter valve(TAVI). There are many available or
in production but the most commonly implanted are the Edwards SAPIEN (Fig. G) and the
Medtronic CoreValve (Fig. H).
7. DESIRED VALVES CONTINUED…
MECHANICAL VALVE
Preferred in young patients:
Who have a life expectancy of more than 10
to 15 years.
Who require long term anticoagulant
therapy for other reasons (e.g., atrial
fibrillation)
BIOPROSTHETICVALVE
Preferred in patients who are elderly:
Who have a life expectancy of less than 10
to 15 years.
Who cannot take long term anticoagulant
therapy.
9. TWO- DIMENSIONAL ECHOCARDIOGRAPHY
Prosthetic valves should be imaged from multiple windows and angles to overcome the problem of
acoustic shadowing that occurs owing to the highly reflective components inherent in many of these
valves.
Nonstandard windows and angles are often required to avoid imaging artifacts. On TTE, LV
function is readily evaluated, but the left atrium is often obscured for imaging and Doppler
interrogation..
The opening and closing of the mechanical valve disks or bioprosthetic cusps must be evaluated.
10. DOPPLER ECHOCARDIOGRAPHY
The Doppler examination includes CF, PW, and CW Doppler examinations. Each method
contributes toward qualifying and quantifying flow patterns of both normal and abnormally
functioning prosthetic valves.
The principles and rationale in utilizing Doppler techniques to qualify, measure, and
quantify blood flow velocities, pressure gradients, and effective valve orifice areas of
prosthetic valves are similar to that of native valves.
However, the “normal” flow profiles of prosthetic valve are NOT assumed to be equal to that
of normal functioning native valves.
11. • COLOR FLOW MAPPING
Paravalvular regurgitation is not uncommon and results from a combination of surgical
technique and the condition of the native annulus.
The severity of prosthetic valve regurgitation is graded by criteria similar to that used for the
native valve.
Although paravalvular regurgitation is always abnormal, small jets are often imaged on CF
Doppler immediately after valve implantation in the operating room. To be clinically and
hemodynamically insignificant, these jets should be small in comparison with the total
circumference of the sewing ring they originate from. Many frequently resolve shortly after
reversal of heparinization.
13. ECHO ASSESSMENT:
Note the transducer position where the optimal Doppler signal was obtained so it may be
used for follow-up studies (most often the apical or para-apical position)
The valve leaflets should be visualized and their mobility noted.
Determine the peak velocity; a peak velocity > 2. 5 m/sec may indicate stenosis or significant
regurgitation.
Determine the pressure half-time; a PHT > 180 ms may be abnormal.
Determine the mitral valve area by the continuity equation.
Determine the mean pressure gradient; a mean pressure gradient > 10 mm Hg may be
abnormal.
Determine the presence and severity of mitral regurgitation
14. ECHO FINDINGS:
2-D PLAX VIEW:
For mechanical valves, imaging perpendicular to the leaflets will allow one to see the opening and closing
by noting the leaflet edges. Imaging parallel to the valve leaflets is not likely to visualize the leaflet edges
opening and closing.
The aortic root may be thickened as a result of hematoma [a solid swelling of clotted blood within the tissues]
and edema after the insertion of a stentless valve as an inclusion inside the aortic root.
A major consideration in the evaluation of prosthetic mitral valve function by echocardiography is the
effect of acoustic shadowing by the prosthesis on assessment of MR. This problem is worse with
mechanical valves than with bioprosthetic valves.
Some appearances which are normal but can cause confusion are: bubbles in the LV, which occur with all
types of valve but especially Bileaflet mechanical valves (caused by aggregations of red cells as a result of
sheer stresses at the leaflet edge as it closes).
15. 2-D PSAX VIEW:
The short-axis view at the level of the prosthesis allows visualization of the leaflet excursion and
sewing ring of a bioprosthetic mitral valve.
For mechanical valves, the short-axis view is limited by acoustic shadowing of the posterior
aspect of the valve sewing ring.
APICAL VIEW:
The apical views allow visualization of leaflet excursion for both bioprosthetic and mechanical
valve prostheses.
Apical views may allow the detection of thrombus or pannus that might limit leaflet excursion.
16. DOPPLER:
the mitral valve prosthesis may obscure(conceal) portions of the left atrium and its posterior wall.
This may prevent detection of small degrees of MR or make it difficult to determine the precise origin
of an MR jet.
Color mapping filling the orifice in all views
during diastole is a useful corroboration of
normal opening.
Figure 1: Normal functioning bioprosthetic valve
in the mitral position.
17. IS THERE EVIDENCE OF OBSTRUCTION?
Most information for the diagnosis of obstruction is found from imaging and colour flow
mapping. Compare measured peak velocity and mean gradient with normal values.
Pressure half-time does not reflect orifice area in normally-functioning prosthetic mitral valves.
However, the pressure half-time lengthens significantly when the valve becomes obstructed.
19. ECHO ASSESSMENT:
Note the transducer position where the optimal Doppler signal was obtained so it may be used
for follow-up studies (most often the apical or right parasternal position)
The valve leaflets should be visualized and their mobility noted.
Determine the peak velocity.
Determine the mean pressure gradient; a mean pressure gradient > 25 mm Hg may be
abnormal.
Determine the aortic valve area using the continuity equation
Determine the velocity ratio
Determine the presence and severity of aortic insufficiency
20. ECHO FINDINGS:
2-D & M- MODE:
In patients with aortic prostheses, measurements of the aortic root and ascending aorta are
recommended.
The cusps should be thin and move freely through an arc of about 90o.
Rocking of the valve is a sign of dehiscence and is seldom(rarely) seen in a normal valve.
Valves should be imaged from multiple views, with particular attention to the following:
the opening and closing motion of the moving parts of the prosthesis;
the presence of leaflet calcifications or abnormal echo density attached to the sewing ring,
occluder, leaflets, stents, or cage; and
On M-mode, mechanical leaflets often flutter slightly.
21. DOPPLER:
All windows should be used but the site of the jet is usually most easily seen in PLAX view
Doppler velocity recordings across normal prosthetic valves usually resemble those of mild
native aortic stenosis, with a maximal velocity usually >2 m/s
In all types of valves, colour should fill the orifice in all planes during systole.
Normal physiological regurgitation through the valveoccurs in all mechanical valves and,
depending on the design, can occur during closing or after closure or throughout diastole
(Fig. 2).
To establish whether the regurgitation is normal or pathological it is necessary to determine
its origin and grade and whether there is thickening of the cusps.
22. 1. Doppler parameters of prosthetic aortic valve function:
Figure 2: Patterns of normal regurgitation.
23. IS THERE EVIDENCE OF OBSTRUCTION?
The definitive signs of obstruction are thickened and immobile biological cusps or stuck
mechanical occlude.
The disc or leaflets of an obstructed mechanical valve may be difficult to image parasternally,
but may be seen more easily from the apical 5-chamber and long-axis views.
25. GENERAL POINTS OF 2D IMAGING OF
PROSTHETIC VALVES
The presence of cusp thickening is usually an early sign of primary failure of a bioprosthetic valve.
Failure of a disk to open will significantly reduce the prosthetic valve’s EOA (effective orifice area)
and thus result in increased pressure gradients across that valve.
Failure to close properly will result in increased regurgitant flow.
Incomplete closure of prosthetic valve leaflets can be due to pannus growth, infection, thrombus, or
suture materials around the sewing ring or the leaflets.
Mechanisms of prosthetic valve dysfunction are both similar to and different from those of the
native valves.
Subtle symptoms of cardiac failure and neurological events can be clues to serious valve dysfunction.
26.
27. PROSTHETIC DYSFUNCTION:
Structural failure:
Any problem with the prosthetic valve structure either mechanical or bioprosthetic such as
ball or disc variance, thrombus, pannus, endocarditis.
For bioprosthetic, evidence of leaflet degeneration can be recognized as:
- Leaflet thickening (cusps >3mm)
- Calcification (bright echoes of the cusps)
- Tear (flail cusps)
Prosthetic dehiscence: it is characterized by the “rocking motion” of entire prosthesis.
Thromboemboli:
Although thrombus formation is frequently associated with valve obstruction,
regurgitation, or embolism, it may be an incidental finding during imaging.
28. Obstruction: thrombus and pannus.
THROMBUS PANNUS
MORPHOLOGY - Larger mass than pannus (>2.8cm)
- Independent motion common
- Project into left atrium
- Grows centrifugally
- Small mass (<2.8cm)
- Mostly involves suture line
- Confined to the disc plane
- Grow beneath disc
CHRONOLOGY Occurs at any time (if late, usually associated with
pannus)
Minimum 12 months.
Commonly 5 years from date surgery.
ABNORMAL PROSTHETIC VALVE
MOTION BY TEE
more common in valves with thrombus Less common
DURATION OF SYMPTOMS obstruction due to thrombus is associated with a short
duration of symptoms and with a history of inadequate
anticoagulation
Comparatively, it is associated with longer duration
of symptoms
FREQUENCY mitral aortic
MOBILITY Independent motion common fixed
ECHO DENSITY (videointensity ratio) Less
<0.4
More
>0.7 (100% specific)
PREVALENCE more less
29. Hemodynamic compromise:
Prosthetic Stenosis:
• the initial suspicion of prosthetic valve stenosis may be the incidental finding of abnormally
high flow velocities detected during a routine examination.
• With increasing stenosis of the valve, a higher velocity and gradient are observed, with longer
duration of ejection and more delayed peaking of the velocity during systole.
• High gradients may be seen with normally functioning valves with a small size, increased stroke
volume, PPM, or valve obstruction. Conversely, a mildly elevated gradient in the setting of severe
LV dysfunction may indicate significant stenosis. Thus, the ability to distinguish malfunctioning
from normal prosthetic valves in high flow states on the basis of gradients alone may be difficult.
Prosthetic Regurgitation:
• Mild regurgitation through a biological valve associated with a thickened cusp is an early sign of
primary failure especially if either the regurgitation or thickening increases on serial studies.
• Rocking of the replacement valve implies that there is a large paraprosthetic leak.
30. Prosthetic endocarditis:
Vegetations are usually irregularly shaped and can be recognized on echocardiography
as independently mobile structures of relatively low echogenicity.
Vegetations in the setting of prosthetic valves tend to form in the valve ring area and
may spread to the leaflet of the prosthetic valve, stent, or occluder and impair the
opening and closing of the valve.
Endocarditis may also lead to suture dehiscence and paravalvular regurgitation in all
prosthetic valves and to valve destruction in Bioprosthetic valves.
Valve PPM(patient-prosthesis mismatch):
This means that the valve is functioning normally but is too small for the patient.
All xenografts have at least mild patient–prosthesis mismatch because the sewing ring
and other valve parts occupy the space normally taken up by blood flow. It does not
cause significant problems unless it is severe.
31. Prosthetic replacement
Mortality including sudden, unexplained death.
DIFFERENTIAL DIAGNOSIS:
Ventricular dysfunction
Pulmonary hypertension
The pathology of the remaining native valves
non cardiac conditions.