{"id":876,"date":"2026-02-18T20:14:57","date_gmt":"2026-02-18T20:14:57","guid":{"rendered":"https:\/\/echokardio.de\/?p=876"},"modified":"2026-02-19T09:14:20","modified_gmt":"2026-02-19T09:14:20","slug":"ase-2023-guidelines-on-prosthetic-valve-function","status":"publish","type":"post","link":"https:\/\/echokardio.de\/en\/2026\/02\/18\/ase-2023-guidelines-on-prosthetic-valve-function\/","title":{"rendered":"ASE 2023 Guidelines on Prosthetic Valve Function"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\">Interactive Algorithms for Prosthetic Aortic and Mitral Valve Assessment<\/h3>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>To facilitate practical implementation in daily echocardiographic practice, two interactive decision algorithms are provided:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prosthetic Aortic Valve (PAV) obstruction assessment<\/strong><\/li>\n\n\n\n<li><strong>Prosthetic Mitral Valve (PMV) obstruction assessment<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Both tools follow the diagnostic logic proposed in the ASE guideline and are intended as educational and clinical support aids.<\/p>\n\n\n\n<p>Full guideline:<br><a href=\"https:\/\/www.asecho.org\/guideline\/evaluation-of-prosthetic-valve-function\/\" rel=\"nofollow noopener\" target=\"_blank\">https:\/\/www.asecho.org\/guideline\/evaluation-of-prosthetic-valve-function\/<\/a><\/p>\n\n\n\n<!-- =========================\n     ASE 2023 \u2013 Prosthetic Valve Stenosis (Interactive)\n     COMPLETE CODE: Aortic + Mitral calculators\n     (Design unchanged; logic aligned to your specification)\n     Paste into ONE HTML widget.\n========================= -->\n\n<!-- ===== AORTIC (PAV) ===== -->\n<meta charset=\"UTF-8\">\n<style type=\"text\/css\">\n  .calculator-title { font-size: 18px; margin-top: 0; }\n  .introduction { margin-top: 20px; margin-bottom: 20px; }\n  .question, .result { margin: 20px 0; display: none; }\n  .restart-button { margin: 20px 0; display: none; text-align: center; }\n  button { margin-right: 10px; }\n<\/style>\n\n<h1 class=\"calculator-title\">Diagnosis of Aortic Prosthetic Stenosis<\/h1>\n\n<p class=\"introduction\">Grading of prosthetic valve regurgitation generally follows the same principles as native valve regurgitation.<\/p>\n<p class=\"introduction\">Additionally, in the case of paravalvular leak, a circumferential PVL extent of &ge; 30% may indicate severe prosthetic regurgitation.<\/p>\n<p class=\"introduction\">This calculator is designed for the diagnosis of unphysiological prosthetic stenosis.<\/p>\n\n<div class=\"question\" id=\"question1\">\n  <p>1. Prosthetic Aortic Jet Velocity &gt; 3 m\/s?<\/p>\n  <button onclick=\"handleAnswer('question1', 'yes')\">Yes<\/button>\n  <button onclick=\"handleAnswer('question1', 'no')\">No<\/button>\n<\/div>\n\n<div class=\"question\" id=\"question2\">\n  <p>2. CW Doppler:<\/p>\n  <ul>\n    <li>Acceleration time (AT) &gt; 100 ms or<\/li>\n    <li>AT\/ET &gt; 0.37?<\/li>\n  <\/ul>\n  <button onclick=\"handleAnswer('question2', 'yes')\">Yes<\/button>\n  <button onclick=\"handleAnswer('question2', 'no')\">No<\/button>\n<\/div>\n\n<div class=\"question\" id=\"question3\">\n  <p>3. Doppler Velocity Index (DVI) = PW Doppler LVOT\/CW Doppler AP:<\/p>\n  <button onclick=\"handleAnswer('question3', 'a')\">&ge; 0.3<\/button>\n  <button onclick=\"handleAnswer('question3', 'b')\">0.29-0.25<\/button>\n<\/div>\n\n<div class=\"question\" id=\"question4\">\n  <p>4. Doppler Velocity Index (DVI) = PW Doppler LVOT\/CW Doppler AP:<\/p>\n  <button onclick=\"handleAnswer('question4', 'a')\">0.29-0.25<\/button>\n  <button onclick=\"handleAnswer('question4', 'b')\">&lt; 0.25<\/button>\n<\/div>\n\n<div class=\"result\" id=\"resultNormal\">\n  <p>Normal aortic prosthesis function.<\/p>\n<\/div>\n\n<div class=\"result\" id=\"resultPossibleStenosis\">\n  <p>Possible stenosis:<\/p>\n  <ul>\n    <li>Consider:<\/li>\n    <li>Valvular stenosis with small LVOT<\/li>\n    <li>Improper position of LVOT PW Doppler<\/li>\n    <li>Underestimation of jet Doppler velocity<\/li>\n    <li>Calculate effective orifice area (EOA) and compare it to reference values of similar valve type and size<\/li>\n  <\/ul>\n<\/div>\n\n<div class=\"result\" id=\"resultStenosis\">\n  <p>Aortic prosthetic stenosis:<\/p>\n  <ul>\n    <li>Consider:<\/li>\n    <li>Valvular stenosis including thrombosis<\/li>\n    <li>Sub-valvular stenosis<\/li>\n    <li>Calculate effective orifice area (EOA) and compare it to reference values of similar valve type and size<\/li>\n  <\/ul>\n<\/div>\n\n<div class=\"result\" id=\"resultUnlikely\">\n  <p>Stenosis is unlikely.<\/p>\n<\/div>\n\n<div class=\"result\" id=\"resultEOA\">\n  <p>1. Perform Effective Orifice Area (EOA) calculation:<\/p>\n  <ul>\n    <li>EOA = [(LVOT diameter \/ 2)\u00b2 \u00d7 \u03c0 \u00d7 LVOT VTI (PW Doppler)] \/ VTI Prosthesis (CW Doppler)<\/li>\n  <\/ul>\n  <p>2. Index EOA to Body Surface Area (BSA):<\/p>\n  <ul>\n    <li>EOA\/BSA<\/li>\n  <\/ul>\n  <p>3. Interpretation:<\/p>\n  <ul>\n    <li>EOA\/BSA &gt; 0.85: Normal, exclude high flow states (e.g., hyperthyroidism).<\/li>\n    <li>EOA\/BSA &lt; 0.85: Suggests Patient-Prosthesis Mismatch (PPM), particularly if observed right after prosthesis implantation.<\/li>\n  <\/ul>\n<\/div>\n\n<div class=\"restart-button\" id=\"restartAortic\">\n  <button onclick=\"restartCalculator()\">Restart Aortic Calculator<\/button>\n<\/div>\n\n<script>\n  \/\/ Aortic calculator init\n  document.getElementById(\"question1\").style.display = \"block\";\n  let answers = {};\n\n  function hideAllAortic() {\n    document.querySelectorAll('.question').forEach(q => q.style.display = \"none\");\n    document.querySelectorAll('.result').forEach(r => r.style.display = \"none\");\n  }\n\n  function handleAnswer(questionId, answer) {\n    hideAllAortic();\n    answers[questionId] = answer;\n\n    switch (questionId) {\n      case 'question1':\n        if (answer === 'yes') {\n          document.getElementById(\"question2\").style.display = \"block\";\n        } else {\n          document.getElementById(\"resultUnlikely\").style.display = \"block\";\n        }\n        break;\n\n      case 'question2':\n        \/\/ YES = Late peak (AT>100 OR AT\/ET>0.37) -> go to DVI (0.29-0.25 vs <0.25)\n        \/\/ NO  = Early peak -> go to DVI (>=0.30 vs 0.29-0.25)\n        if (answer === 'yes') {\n          document.getElementById(\"question4\").style.display = \"block\";\n        } else {\n          document.getElementById(\"question3\").style.display = \"block\";\n        }\n        break;\n\n      case 'question3':\n        \/\/ Early peak branch\n        if (answer === 'a') {\n          \/\/ DVI >=0.30 -> Normal + advise EOA index to distinguish high flow vs PPM\n          document.getElementById(\"resultNormal\").style.display = \"block\";\n          document.getElementById(\"resultEOA\").style.display = \"block\";\n        } else {\n          \/\/ DVI 0.29\u20130.25 -> Possible stenosis\n          document.getElementById(\"resultPossibleStenosis\").style.display = \"block\";\n        }\n        break;\n\n      case 'question4':\n        \/\/ Late peak branch\n        if (answer === 'a') {\n          \/\/ DVI 0.29\u20130.25 -> Possible stenosis\n          document.getElementById(\"resultPossibleStenosis\").style.display = \"block\";\n        } else {\n          \/\/ DVI <0.25 -> Stenosis\n          document.getElementById(\"resultStenosis\").style.display = \"block\";\n        }\n        break;\n    }\n\n    document.getElementById(\"restartAortic\").style.display = \"block\";\n  }\n\n  function restartCalculator() {\n    hideAllAortic();\n    answers = {};\n    document.getElementById(\"restartAortic\").style.display = \"none\";\n    document.getElementById(\"question1\").style.display = \"block\";\n  }\n<\/script>\n\n<hr style=\"margin:30px 0\">\n\n<!-- ===== MITRAL (PrMV) ===== -->\n<!DOCTYPE html>\n<html lang=\"en\">\n<head>\n  <meta charset=\"UTF-8\">\n  <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\n  <title>Diagnosis of Prosthetic Mitral Valve (PrMV) Stenosis<\/title>\n  <style>\n    .input-container {\n      margin-top: 10px;\n      margin-bottom: 10px;\n      border: 1px solid rgb(187, 187, 187);\n      border-radius: 5px;\n      padding: 5px 10px;\n      padding-bottom: 10px;\n    }\n    .input { margin-top: 5px; margin-bottom: 10px; width: max-content; }\n    .input>input, .input>select { width: 75px; }\n    .output {\n      display: block;\n      width: fit-content;\n      padding: 3px 8px;\n      border-radius: 5px;\n      margin: 2px;\n      margin-bottom: 10px;\n      color: #fff;\n      font-weight: bold;\n    }\n    .box { margin: 10px; padding: 10px 15px; border: 1px solid grey; background-color: #ebebeb; border-radius: 5px; }\n    h3, h4 { margin: 5px 0; }\n    h4 { margin-bottom: 10px; }\n    .checkButton { margin: 5px 0; }\n    .radio { display: block; width: 100%; }\n    .radio>label>input { margin-right: 8px; }\n    .notcomplete { background-color: #777; }\n    .normal { background-color: #4D8A30; }\n    .possible { background-color: #DE581F; }\n    .significant { background-color: #BA0A07; }\n  <\/style>\n<\/head>\n\n<body>\n  <div style=\"margin: 10px\">\n    <div class=\"box\">\n      <h3><b>Diagnosis of Prosthetic Mitral Valve (PrMV) Stenosis<\/b><\/h3>\n      <p>\n        Grading of prosthetic valve regurgitation generally follows the same principles as native valve regurgitation.\n        Additionally, conditions such as valve dehiscence, incomplete occluder closure, and bioprosthetic flail leaflet\n        may indicate severe prosthetic regurgitation. This calculator is designed for the diagnosis of unphysiological\n        prosthetic stenosis. However, some criteria mentioned below may also be abnormal in the presence of significant\n        prosthetic MR, such as a peak velocity greater than 1.9 m\/s.\n      <\/p>\n\n      <div class=\"input-container\">\n        <h4>CW Doppler: Peak Velocity (m\/s)<\/h4>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q1\" value=\"a\" \/>&lt; 1.9<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q1\" value=\"b\" \/>1.9-2.5<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q1\" value=\"c\" \/>\u2265 2.5<\/label><\/div>\n      <\/div>\n\n      <div class=\"input-container\">\n        <h4>CW Doppler: Mean gradient (mm Hg)<\/h4>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q2\" value=\"a\" \/>\u2264 5<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q2\" value=\"b\" \/>6-10<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q2\" value=\"c\" \/>&gt; 10<\/label><\/div>\n      <\/div>\n\n      <div class=\"input-container\">\n        <h4>VTI PrMV \/ VTI LVOT<\/h4>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q3\" value=\"a\" \/>&lt; 2.2<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q3\" value=\"b\" \/>2.2-2.5<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q3\" value=\"c\" \/>&gt; 2.5<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q3\" value=\"d\" \/>N\/A<\/label><\/div>\n      <\/div>\n\n      <div class=\"input-container\">\n        <h4>Effective Orifice Area (EOA, cm\u00b2)<\/h4>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q4\" value=\"a\" \/>\u2265 2.0<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q4\" value=\"b\" \/>1-2<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q4\" value=\"c\" \/>&lt; 1<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q4\" value=\"d\" \/>N\/A<\/label><\/div>\n      <\/div>\n\n      <div class=\"input-container\">\n        <h4>Pressure Half Time (PHT, ms)<\/h4>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q5\" value=\"a\" \/>&lt; 130<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q5\" value=\"b\" \/>130-200<\/label><\/div>\n        <div class=\"radio\"><label><input type=\"radio\" name=\"q5\" value=\"c\" \/>&gt; 200<\/label><\/div>\n      <\/div>\n\n      <div id=\"resultDisplay\"><\/div>\n      <button class=\"checkButton\" onclick=\"evaluateResults()\">Calculate<\/button>\n    <\/div>\n  <\/div>\n\n  <script>\n    function evaluateResults() {\n      const questions = ['q1', 'q2', 'q3', 'q4', 'q5'];\n      let allAnswered = true;\n\n      let nNormal = 0, nPossible = 0, nSignificant = 0; \/\/ a,b,c counts; d is ignored (N\/A)\n\n      for (const q of questions) {\n        const selected = document.querySelector(`input[name=\"${q}\"]:checked`);\n        if (!selected) { allAnswered = false; continue; }\n\n        const v = selected.value;\n        if (v === 'd') continue;      \/\/ N\/A -> ignore\n        if (v === 'a') nNormal++;\n        if (v === 'b') nPossible++;\n        if (v === 'c') nSignificant++;\n      }\n\n      let resultText = \"\";\n      let className = \"\";\n\n      if (!allAnswered) {\n        resultText = \"Please complete the form\";\n        className = \"output notcomplete\";\n      } else {\n        \/\/ SIGNIFICANT (guideline-style: multiple parameters in significant range)\n        if (nSignificant >= 2 || (nSignificant >= 1 && nPossible >= 2)) {\n          resultText = \"Suggests significant stenosis. Consider valvular stenosis (including thrombosis). Further examination (e.g., TEE) is recommended.\";\n          className = \"output significant\";\n        }\n        \/\/ POSSIBLE\n        else if ((nPossible + nSignificant) >= 2) {\n          resultText = \"Possible stenosis. Correlate with flow state\/heart rate and patient\u2013prosthesis mismatch (PPM). Further examination (e.g., TEE) may be indicated.\";\n          className = \"output possible\";\n        }\n        \/\/ NORMAL\n        else {\n          resultText = \"Findings consistent with normal prosthetic mitral valve function.\";\n          className = \"output normal\";\n        }\n      }\n\n      const out = document.getElementById('resultDisplay');\n      out.textContent = resultText;\n      out.className = className;\n    }\n  <\/script>\n<\/body>\n<\/html>\n\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[],"class_list":["post-876","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/paCb4I-e8","jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/posts\/876","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/comments?post=876"}],"version-history":[{"count":7,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/posts\/876\/revisions"}],"predecessor-version":[{"id":900,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/posts\/876\/revisions\/900"}],"wp:attachment":[{"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/media?parent=876"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/categories?post=876"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/echokardio.de\/en\/wp-json\/wp\/v2\/tags?post=876"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}