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Echocardiographic evaluation of prosthetic heart valves

Elyse Foster, MD
Section Editors
Warren J Manning, MD
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Echocardiography is the key noninvasive modality for evaluation of prosthetic valve structure and function [1]. Transthoracic echocardiography (TTE) is the mainstay for monitoring prosthetic valves and can generally identify normal function as well as evidence of valve dysfunction (stenosis). Transesophageal echocardiography (TEE) is helpful particularly for assessment of valve structure and prosthetic valve regurgitation, especially involving mechanical mitral and tricuspid prostheses as well as assessment of endocarditis for all valves (figure 1).

This topic will review echocardiography of prosthetic heart valves. Management of patients with prosthetic heart valves and prosthetic valve complications are discussed separately. (See "Diagnosis of mechanical prosthetic valve thrombosis or obstruction" and "Epidemiology, clinical manifestations, and diagnosis of prosthetic valve endocarditis" and "Antithrombotic therapy for prosthetic heart valves: Indications" and "Overview of the management of patients with prosthetic heart valves".)


Baseline transthoracic echocardiogram — We agree with the American Heart Association/American College of Cardiology (AHA/ACC) guideline recommendation to perform a transthoracic echocardiogram (TTE) six weeks to three months after valve implantation to evaluate valve hemodynamics and to establish a baseline for future comparison [2]. The TTE should include Doppler measurements of transvalvular velocities as well as assessment of valvular and paravalvular regurgitation. Adequate Doppler velocity recordings can generally be obtained despite acoustic shadowing from valve prostheses.

Transvalvular gradients for normally functioning prosthetic valves are dependent upon valve type, location, and size (as compiled in the 2009 American Society of Echocardiography guidelines) as well as patient-specific factors [1]. A higher than expected initial gradient is often due to a high output state (eg, due to anemia) or patient-prosthetic mismatch and is only rarely due to early dysfunction of the prosthesis. We suggest obtaining the postoperative baseline study after the patient’s hemoglobin has returned to baseline to avoid recording a gradient that is transiently higher than expected due to anemia.

Change in clinical status — The echocardiographer should be alert to the range of complications that can occur with prosthetic devices, including the following (see "Diagnosis of mechanical prosthetic valve thrombosis or obstruction"):

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Literature review current through: Nov 2017. | This topic last updated: Dec 22, 2016.
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