Assessment of normal hemodynamic profile of mechanical pulmonary prosthesis by doppler echocardiography: a prospective cross-sectional study

Maryam Shojaeifard,Maryam Moradian,Ali Daryanavard,Hossein Dehghani Mohammad Abadi,Sajjad Erami,Arman Karimi Behnagh

doi:10.1186/s12947-020-00196-0

Abstract

ObjectivesVery few reports have described the Doppler-derived echocardiographic parameters for mechanical pulmonary valve prosthesis (MPVP). This study aims to describe the normal Doppler hemodynamic profile of MPVP using Doppler echocardiography.MethodsThe current prospective, single center observational study enrolled 108 patients who underwent pulmonary valve replacement (PVR) surgery for the first time and had a normally functioning prosthesis post-operation. The hemodynamic performance of MPVPs, considering flow dependent and flow independent parameters, was evaluated at two follow-up points, at week one and week four post-operation. All assessments were conducted by an experienced echocardiographer.ResultsThe mean age (±SD) of the participants was 26.4 (±8.98). Tetralogy of Fallot (ToF) was the most common underlying disease leading to PVR, with a prevalence of 88%. At first week post-operation, measurement of indices reported the following values (±SD): peak pressure gradient (PPG): 18.51(±7.64) mm Hg; mean pressure gradient (MPG): 10.88(±5.62) mm Hg; peak velocity (PV): 1.97(±0.43)m/s; doppler velocity index (DVI): 0.61(±18); pulmonary velocity acceleration time (PVAT): 87.35(±15.16) ms; effective orifice area (EOA): 2.98(±1.02) cm2;and effective orifice area to body surface area ratio (EOA/ BSA): 1.81(±0.62) cm2/m2. Comparing these measurements with those obtained from the second follow-up (at week four post-op) failed to hold significant difference in all values except for PVAT, which had increased from its primary value (p = 0.038). Also, right ventricular (RV) function showed significant improvement throughout the follow up period.ConclusionThe findings of this study help strengthen the previously scarce data pool and better establish the normal values for Doppler hemodynamics in mechanical pulmonary prosthesis.

Highlights

In recent years, mortality rates due to congenital cardiac anomalies have significantly declined, leading to the prolongation of lifespan in affected individuals
All eligible cases were present for their first follow up, only 69 individuals visited the center for their second follow up
In this study, we have described the normal hemodynamic profile for mechanical pulmonary valve prosthesis in the postoperative period

Summary

Introduction

Mortality rates due to congenital cardiac anomalies have significantly declined, leading to the prolongation of lifespan in affected individuals. Amongst such anomalies, congenital defects of the right-side chambers are commonly managed with Pulmonary Valve Replacement (PVR). Mechanical valves are more durable, the use of these prosthesis is associated with an increased risk for thrombotic events requiring lifelong anticoagulation therapy. This renders them less favourable over the alternate option. It has been suggested that the implication of proper anticoagulation therapies can significantly reduce the risk of thrombotic events [4]

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