Accuracy of Doppler-echocardiographic parameters for the detection of aortic bileaflet mechanical prosthetic valve dysfunction

Othman Smadi, Julio Garcia, Philippe Pibarot, Emmanuel Gaillard, Ibrahim Hassan, Lyes Kadem

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Aims In vitro and in vivo studies were performed to evaluate the diagnostic accuracy of the different Doppler-echocardiographic parameters proposed in the American Society of Echocardiography guidelines to identify dysfunction of bileaflet mechanical valves (BMV) in the aortic position. Methods and results Two models of BMV (St Jude HP, MCRI On-X) of different sizes (21;23;25;27 mm) were tested in vitro under a wide range of cardiac outputs (3-7 L/min). The motion of one or both leaflets was restricted to induce a mild (25% restriction in total valve orifice area) and moderate-to-severe (50% restriction in total valve area). Doppler-echocardiographic parameters of valve function were also measured in 17 patients with BMV of whom 4 had valve dysfunction confirmed by cinefluoroscopy. The specificity of all the parameters was high (in vitro: 83-100%; in vivo: 69-100%), but the sensitivity was low (range: 0-83% and 25-100%, respectively). A higher cut-off value for the ratio of peak left ventricular outflow tract velocity to peak aortic velocity or Doppler velocity index (DVI) (<0.35 instead of 0.3 or 0.25) improved the sensitivity (>90%) for the detection of moderate-to-severe dysfunction but remained low for mild dysfunction (50%). Furthermore, a difference of normal reference effective orifice area (EOA) minus measured EOA (EOA-D) >1 standard deviation identified mild and moderate-to-severe dysfunction with sensitivity of 61 and 100%, respectively. Conclusion The Doppler-echocardiographic parameters and criteria proposed in the guidelines lack sensitivity for the detection of BMV dysfunction. The utilization of a DVI < 0.35 or an EOA-D > 1 SD improved the sensitivity (>90%) for the detection of moderate-to-severe dysfunction, but the sensitivity remained suboptimal (<65%) for detection of mild dysfunction.

Original languageEnglish
Pages (from-to)142-151
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number2
Publication statusPublished - Feb 2014
Externally publishedYes



  • Aortic stenosis
  • Doppler echocardiography
  • Prosthetic heart valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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