Recommendations for Evaluation of Prosthetic Valves With ...

1 GUIDELINES AND STANDARDS. Recommendations for Evaluation of Prosthetic Valves With echocardiography and doppler Ultrasound A Report From the American Society of echocardiography 's Guidelines and Standards Committee and the Task Force on Prosthetic Valves , Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of echocardiography , a registered branch of the European Society of Cardiology, the Japanese Society of echocardiography and the Canadian Society of echocardiography , Endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of echocardiography , a registered branch of the European Society of Cardiology, the Japanese Society of echocardiography , and Canadian Society of echocardiography William A.

2 Zoghbi, MD, FASE, Chair, John B. Chambers, MD,* Jean G. Dumesnil, MD, Elyse Foster, MD, . John S. Gottdiener, MD, FASE, Paul A. Grayburn, MD, Bijoy K. Khandheria, MBBS, FASE, Robert A. Levine, MD, Gerald Ross Marx, MD, FASE, Fletcher A. Miller, Jr., MD, FASE, Satoshi Nakatani, MD, PhD, Miguel A. Quin ones, MD, Harry Rakowski, MD, FASE, L. Leonardo Rodriguez, MD, Madhav Swaminathan, MD, FASE, Alan D. Waggoner, MHS, RDCS, Neil J. Weissman, MD, FASE,k and Miguel Zabalgoitia, MD, Houston and Dallas, Texas; London, United Kingdom; Quebec City, Quebec, Canada;. San Francisco, California; Baltimore, Maryland; Scottsdale, Arizona; Boston, Massachusetts; Rochester, Minnesota;. Suita, Japan; Toronto, Ontario, Canada; Cleveland, Ohio; Durham, North Carolina; St Louis, Missouri.

3 Washington, DC; Springfield, Illinois Accreditation Statement: The American Society of echocardiography is accredited by the Accreditation Council for Continu- ing Medical Education to provide continuing medical education for physicians. From the Methodist DeBakey Heart and Vascular Center, Houston, Texas ( , The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit . Phy- ); St Thomas Hospital, London, United Kingdom ( ); Hospital Laval, sicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing In- Quebec City, Quebec, Canada ( ); the University of California, San ternational recognize the ASE's certificates and have agreed to honor the credit hours toward their Francisco, San Francisco, California ( ); the University of Maryland Hospital, registry requirements for sonographers.

4 Baltimore, Maryland ( ); Baylor University Medical Center, Dallas, Texas The ASE is committed to ensuring that its educational mission and all sponsored educational pro- ( ); Mayo Clinic, Scottsdale, Arizona ( ); Massachusetts General grams are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the Hospital, Boston, Massachusetts ( ); Harvard School of Medicine/Boston goals and educational integrity of the activity. Although a monetary or professional affiliation Children's Hospital, Boston, Massachusetts ( ); the Mayo Clinic, with a corporation does not necessarily influence an author's presentation, the essential areas Rochester, Minnesota ( ); Osaka University Graduate School of Medicine, and policies of the ACCME require that any relationships that could possibly conflict with the Suita, Japan ( ); Toronto General Hospital, Toronto, Ontario, Canada ( ); educational value of an activity be resolved prior to publication and disclosed to the audience.

5 Dis- closures of faculty and commercial support relationships, if any, have been indicated. the Cleveland Clinic, Cleveland, Ohio ( ); Duke University Medical Center, Target Audience: Durham, North Carolina ( ); Washington University School of Medicine, St This activity is designed for all cardiovascular physicians and cardiac sonographers with a primary Louis, Missouri ( ); Washington Hospital Center, Washington, DC ( ); interest and knowledge base in the field of echocardiography . In addition, residents, researchers, cli- and Prairie Cardiovascular Consultants, Springfield, Illinois ( ). nicians, intensivists, and other medical professionals with specific interest in cardiac ultrasound will find this activity beneficial. Reprint requests: American Society of echocardiography , 2100 Gateway Centre Objectives: Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: Upon completing this article, participants will be better able to: * Representing the European Association of echocardiography .)

6 Representing the 1. Name the components of a complete imaging and doppler Evaluation for Prosthetic valve func- Canadian Society of echocardiography . Representing the Cardiac Imaging tion. Committee of the American Heart Association. Representing the Japanese 2. Identify the components of an integrative approach to assessing Prosthetic aortic and mitral valve Society of Representing the American College of Cardiology stenosis and regurgitation. 3. Identify the components of an integrative approach to assessing Prosthetic pulmonary and tricus- Cardiovascular Imaging Committee. pid valve stenosis and regurgitation. 0894-7317/$ 4. Describe the pitfalls and limitations of the Evaluation of Prosthetic valve function. 5. Recognize the special aspects of the pediatric population that add complexity to the Evaluation Copyright 2009 by the American Society of echocardiography .

7 Of Prosthetic valve function. 975. 976 Zoghbi et al Journal of the American Society of echocardiography September 2009. Author Disclosures: 4. An Integrative Approach in Evaluating Prosthetic AR 991. Elyse Foster receives research and grant support from Evalve (Menlo Park, CA), Boston Scientific IV. Evaluation of Prosthetic Mitral Valves 991. Corporation (Natick, MA), and Evidence Based Research, Inc (Vienna, VA). Paul A. Grayburn is A. Prosthetic Mitral Valve Function and Stenosis 991. the Associate Editor of the American Journal of Cardiology and receives research support from 1. Imaging Considerations 991. the National Institutes of Health (Bethesda, MD), Evalve (Menlo Park, CA), GE (Milwaukee, WI), and Amersham (Amersham, UK). Harry Rakowski chairs the Data Safety Monitoring Board for a.

8 Parasternal Views 991. Medtronic, Inc (Minneapolis, MN). Neil J. Weissman receives research/grant support from ATS b. Apical Views 992. Medical, Inc (Minneapolis, MN), Sorin/Carbomedics (Milan, Italy), Edwards Lifesciences (Irvine, 2. doppler Parameters of Prosthetic Mitral Valve Function 992. CA), St Jude Medical (St Paul, MN), MitralSolutions, Inc (Fort Lauderdale, FL), Arbor Surgical Tech- a. Peak Early Mitral Velocity 992. nologies (Sunnyvale, CA), Evalve (Menlo Park, CA) Mitralign, Inc (Tewksbury, MA), Medispec (Ger- mantown, MD), and Direct Flow Medical, Inc (Santa Rosa, CA). b. Mean Gradient 993. William A. Zoghbi, John B. Chambers, Jean G. Dumesnil, John S. Gottdiener, Bijoy K. Khandheria, c. Pressure Half-Time 993. Robert A. Levine, Gerald Ross Marx, Fletcher A.

9 Miller, Jr, Satoshi Nakatani, Miguel A. Quin ones, L. d. EOA 994. Leonardo Rodriguez, Madhav Swaminathan, Alan D. Waggoner, and Miguel Zabalgoitia all re- e. DVI 995. ported that they have no actual or potential conflicts of interest in relation to this program. Con ict of Interest: 3. Diagnosis of Prosthetic Mitral Valve Stenosis 995. This activity has been peer reviewed by a nonbiased member of the ASE ACCME/CME commit- B. Prosthetic Mitral Valve Regurgitation 996. tee. No indication of an actual or potential bias in relation to the author disclosures was determined. 1. Imaging Considerations 996. Estimated Time to Complete This Activity: 1hour 2. Role of TEE 996. 3. Assessment of Severity of Prosthetic MR 996. V. Evaluation of Prosthetic Pulmonary Valves 996.

10 TABLE OF CONTENTS A. Prosthetic Pulmonary Valve Function 996. 1. Imaging Considerations 996. 2. Evaluation of Pulmonary Valve Function 998. I. Introduction 976 B. Prosthetic Pulmonary Valve Regurgitation 998. II. General Considerations With Prosthetic Valves 977 VI. Evaluation of Prosthetic Tricuspid Valves 998. A. Types of Prosthetic Valves 977 A. Prosthetic Tricuspid Valve Function 998. B. Evaluation of Prosthetic Valves With echocardiography and doppler : 1. Imaging Considerations 998. General Recommendations 977 2. doppler Parameters of Tricuspid Prosthetic Valve Function 999. 1. Clinical Data 978 3. Diagnosis of Prosthetic Tricuspid Valve Stenosis 999. 2. Echocardiographic Imaging 978 B. Prosthetic TR 1000. 3. doppler echocardiography 979 1.