1003-1 Serial Assessment of Doppler Hemodynamic Profiles in Fifty Clinically and Echocardiographically Normal Tricuspid Valve Prostheses

Abstract

Normal Doppler hemodynamics of tricuspid valve prostheses (TP) have been established; the variability of TP hemodynamics over time has not been previously described. Thus we analyzed 2 or more (total 133) comprehensive sequential echo-Doppler exams from 50 patients (18 M: 33 F; mean age 44 ± 22 yrs) with clinically and echo normal TP (28 mechanical: 22 bioprosthetic). The earliest complete postop echo-Doppler exam from each patient was chosen as the index study; subsequent Doppler exams performed at mean 1.5 ± 0.8 yrs after the index study were analyzed. The mean values ±SD of early velocity, atrial velocity, pressure half-time (PHT), and mean gradient (MG) were obtained by digitizing 10 cycles for each TP study. The change (Δ) between studies was established for each parameter among valve types. The tricuspid bioprosthetic MG increased 0.8 ± 1.6 mmHg between the index and second study (p = 0.03) and continued to increase at a rate of 0.4 mmHg/yr (p = 0.001). This increase was not seen in mechanical valves. The PHT increased among all TP types with time (p = 0.001), and was significantly related to a decrease in heart rate (p = 0.003) for bioprosthetic but not for the mechanical TP. After adjusting for changes in heart rate, the increase in PHT was less significant (p = 0.052). No other significant changes among valve types over time were noted. Serial echo-Doppler studies of clinically normal bioprosthetic TP demonstrate a significant increase in MG over time. Longer follow-up will be required to determine if the increasing MG for bioprostheses continues at a steady rate. Similar changes were not seen for mechanical TP, hence an increasing gradient in this setting requires further evaluation to exclude pathologic obstruction.