title: Pitfalls in interpreting bioprosthetic aortic valve pressure gradients: a cautionary tale!
abstract: High transvalvular pressure gradients following aortic valve replacement can be caused by several possible mechanisms. We present the case of an elderly woman with an elevated pressure gradient across an aortic valve bioprosthesis in the setting of complete heart block. After consideration of the presence of complete heart block, the hemodynamic profile of the specific prosthesis, and patient-prosthesis mismatch, only a mild degree of stenosis was found to be attributable to degeneration of the prosthesis. There is no literature quantifying the hemodynamic effect of complete heart block on the pressure gradients across bioprosthetic aortic valves. In the case presented, the transvalvular peak and mean pressure gradients were reduced by 41% and 39%, respectively, following treatment of complete heart block by insertion of a permanent pacemaker.
authors: Cardiac Services, Mackay Base Hospital, Mackay, Queensland, Australia. stefanbuchholz@hotmail.com
authors: Stefan
authors: S
authors: Buchholz
authors: Daniel
authors: D
authors: Robaei
authors: Neil H
authors: NH
authors: Jacobs
authors: Michael P
authors: MP
authors: Feneley
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D062186:Arterial Pressure; D001705:Bioprosthesis / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006327:Heart Block / Q000000981:diagnostic imaging* / Q000209:etiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome