Interactive Algorithms for Prosthetic Aortic and Mitral Valve Assessment
The 2023 ASE recommendations provide a structured framework for the evaluation of prosthetic valve function, integrating Doppler parameters, jet contour analysis, DVI/VTI ratios, acceleration time, and effective orifice area.
To facilitate practical implementation in daily echocardiographic practice, two interactive decision algorithms are provided:
- Prosthetic Aortic Valve (PAV) obstruction assessment
- Prosthetic Mitral Valve (PMV) obstruction assessment
Both tools follow the diagnostic logic proposed in the ASE guideline and are intended as educational and clinical support aids.
Full guideline:
https://www.asecho.org/guideline/evaluation-of-prosthetic-valve-function/
Diagnosis of Aortic Prosthetic Stenosis
Grading of prosthetic valve regurgitation generally follows the same principles as native valve regurgitation.
Additionally, in the case of paravalvular leak, a circumferential PVL extent of ≥ 30% may indicate severe prosthetic regurgitation.
This calculator is designed for the diagnosis of unphysiological prosthetic stenosis.
1. Prosthetic Aortic Jet Velocity > 3 m/s?
2. CW Doppler:
- Acceleration time (AT) > 100 ms or
- AT/ET > 0.37?
3. Doppler Velocity Index (DVI) = PW Doppler LVOT/CW Doppler AP:
4. Doppler Velocity Index (DVI) = PW Doppler LVOT/CW Doppler AP:
Normal aortic prosthesis function.
Possible stenosis:
- Consider:
- Valvular stenosis with small LVOT
- Improper position of LVOT PW Doppler
- Underestimation of jet Doppler velocity
- Calculate effective orifice area (EOA) and compare it to reference values of similar valve type and size
Aortic prosthetic stenosis:
- Consider:
- Valvular stenosis including thrombosis
- Sub-valvular stenosis
- Calculate effective orifice area (EOA) and compare it to reference values of similar valve type and size
Stenosis is unlikely.
1. Perform Effective Orifice Area (EOA) calculation:
- EOA = [(LVOT diameter / 2)² × π × LVOT VTI (PW Doppler)] / VTI Prosthesis (CW Doppler)
2. Index EOA to Body Surface Area (BSA):
- EOA/BSA
3. Interpretation:
- EOA/BSA > 0.85: Normal, exclude high flow states (e.g., hyperthyroidism).
- EOA/BSA < 0.85: Suggests Patient-Prosthesis Mismatch (PPM), particularly if observed right after prosthesis implantation.
Diagnosis of Prosthetic Mitral Valve (PrMV) Stenosis
Grading of prosthetic valve regurgitation generally follows the same principles as native valve regurgitation. Additionally, conditions such as valve dehiscence, incomplete occluder closure, and bioprosthetic flail leaflet may indicate severe prosthetic regurgitation. This calculator is designed for the diagnosis of unphysiological prosthetic stenosis. However, some criteria mentioned below may also be abnormal in the presence of significant prosthetic MR, such as a peak velocity greater than 1.9 m/s.
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