Evaluation of mechanical prosthetic valves: the role of three dimensional echocardiography in calculating effective orif
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ORIGINAL PAPER
Evaluation of mechanical prosthetic valves: the role of three dimensional echocardiography in calculating effective orifice area in obese vs non‑obese individuals Demet Ozkaramanli Gur1 · Derya Baykiz2 · Ozcan Gur3 · Seref Alpsoy1 · Aydin Akyuz1 · Selami Gurkan3 Received: 1 June 2020 / Accepted: 18 August 2020 © Springer Nature B.V. 2020
Abstract Calculation of effective orifice area (EOA) is crucial for the evaluation of prosthetic valve (PV) function and there is lack of data on the best method, particularly in obese patients, in whom two-dimensional (2D) transthoracic echocardiography (TTE) is cumbersome. We sought to compare two methods of calculating EOA through Continuity equation; one using standard 2D-TTE and other three-dimensional (3D) stoke volume (SV), in patients with bileaflet mechanical PV stratified by body mass index (BMI). On conventional TTE, SV mas measured using standard 2D derived data and 3D derived SV in 38 aortic and 62 mitral PV patients who were referred for further evaluation for mild/moderate symptoms of dyspnea. Patients were categorized with regard to transprosthetic flow into ‘normal-flow’ and ‘high-flow’ groups and several echocardiographic data including 2D and 3D EOA were compared. Rates of obesity (BMI ≥ 30) were similar within high and normal flow groups of mitral and aortic PV patients. Correlation and agreement of 2D and 3D EOA was sought in patients with and without obesity. After identifying patients with possible severe obstruction, ROC analysis was carried out to identify whether 2D and 3D derived EOA could discriminate those with obstruction. There was good correlation and agreement between two methods in patients without obesity in both mitral and aortic PV. In obese individuals, however, there was no correlation between 2D and 3D EOA; in whom echocardiographic criteria showing severe obstruction revealed that 3D EOA measurements were more accurate. ROC analysis supported that 3D EOA performs better to identify patients with obstructive characteristics. In patients with bileaflet PV, measurement of EAO by 3D derived SV yields more accurate results irrespective of BMI. Keywords Prosthetic valve · Effective orifice area · Obesity · Three dimensional echocardiography
Introduction Hemodynamic performance of prosthetic heart valves (PV) is inferior to normally functioning native valves, making regular assessment with transthoracic echocardiography (TTE) crucial in the follow-up [1, 2]. Although TTE has advantages of being noninvasive and low-cost, evaluation of mechanical PV is challenging due to limitations of acoustic shadowing * Demet Ozkaramanli Gur [email protected] 1
Department of Cardiology, Faculty of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
2
Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
3
Department of Cardiovascular Surgery, Faculty of Medicine, Namik Kemal University, Tekirdaǧ, Turkey
and reverberation artifacts. Poor acoustic windows further complicate this examination in obese i
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