Comprehensive echocardiographic assessment of normal mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount bioprostheses early after implantation.
BACKGROUND
Normal Doppler-derived hemodynamic data for mitral valve bioprostheses are limited.


METHODS
To establish parameters for identifying normal function for each of the 3 types of bioprostheses examined, we conducted a comprehensive, retrospective, two-dimensional, and Doppler echocardiographic assessment of 179 patients who underwent implantation of the Medtronic Hancock II or the Medtronic Mosaic (Medtronic, Inc, Minneapolis, MN) porcine mitral valve bioprosthesis or the Carpentier-Edwards Perimount (Edwards Lifesciences LLC, Irvine, CA) bovine pericardial mitral valve bioprosthesis.


RESULTS
All bioprostheses were normal by clinical examination, intraoperative transesophageal echocardiography, and postoperative transthoracic echocardiography. Regardless of valve type and body surface area, the pressure half-time was < 124 ms in all patients. Mean gradient < 9.5 mm Hg, mitral E velocity < 2.6 m/s, mitral valve prosthesis time-velocity integral < 69 cm, and ratio of the mitral valve prosthesis time-velocity integral to the left ventricular outflow tract time-velocity integral < 3.4 were recorded in nearly all patients.


CONCLUSIONS
These cutoff values (mean + 2 standard deviation) are specific, but not sensitive, for identifying mitral valve prosthesis dysfunction. Prostheses with hemodynamic values that are higher than these cutoff values are likely dysfunctional, but in select cases, mitral valve prosthesis dysfunction may be present even when hemodynamic values are lower than these thresholds.
Blauwet
Lori A
LA
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Malouf
Joseph F
JF
Connolly
Heidi M
HM
Hodge
David O
DO
Evans
Katie N
KN
Herges
Regina M
RM
Sundt
Thoralf M
TM
Miller
Fletcher A
FA
D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D011474:Prosthesis Design; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity