Patient –Prosthesis Mismatch Vera H. Rigolin, MD, FASE Vice-President, American Society of Echocardiography Professor of Medicine Northwestern University Bluhm Cardiovascular Institute Medical Director, Echocardiography Laboratory Northwestern Memorial Hospital Chicago, IL USA
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Patient –Prosthesis Mismatch · Patient –Prosthesis Mismatch Vera H. Rigolin, MD, FASE Vice-President, American Society of Echocardiography. Professor of Medicine. Northwestern
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Patient –Prosthesis Mismatch
Vera H. Rigolin, MD, FASEVice-President, American Society of Echocardiography
• 1985-2000• 388 patients who underwent St. Jude AVR• Echo within 1 yr after AVR• Severe PPM EOAI < 0.6 cm/m2, Mod 0.6-0.85 cm/m2,
Normal > 0.85 cm/m2)• Severe 66 ( 17%), Moderate 168 ( 43%), normal ( 40%)
Mohty-Echahidi et al. Circ 2006; 113: 420-6
Mohty-Echahidi et al. Circ 2006; 113: 420-6
Mohty-Echahidi et al. Circ 2006; 113: 420-6
• 571 pts who had a bioprosthetic AVR• 1/2005- 12/2008• 146( 26%) were included in this study• Inclusion:• Normal LVEF• Baseline and follow up echo at least 6 months after the date of
surgery• PPM assessed with 1) ASE methods, 2) manufacturer’s table, and
3) measured EOAiChacko et al. Circ Img 2013; 6: 776-83
Chacko et al. Circ Img 2013; 6: 776-83
Chacko et al. Circ Img 2013; 6: 776-83
Treatment
• Avoid severe PPM–Enlarge aortic root–Use stentless valve or other low
profile prosthesis• May tolerate mild to mod PPM in
an older/sedentary patient• Females and large BSA at most risk
Summary
• Various methods to calculate PPM • Echo-derived EOAi is dependent on
accurate measurements• Severe PPM may impact survival• Pts with low EF most vulnerable • Avoidance of PPM is the best
treatment
Thank You
Presenter
Presentation Notes
Thank you for your time and attention and I’d be happy to take any questions at this time.