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  • Title: Doppler assessment of mechanical aortic valve prostheses: effect of valve design and size of the aorta.
    Author: Mascherbauer J, Schima H, Maurer G, Baumgartner H.
    Journal: J Heart Valve Dis; 2004 Sep; 13(5):823-30. PubMed ID: 15473486.
    Abstract:
    BACKGROUND AND AIM OF THE STUDY: Discrepancies between Doppler and catheter gradients have been reported for bileaflet aortic valve prostheses. Whether modifications in geometric design of newly developed bileaflet valves lead to a different Doppler-catheter gradient relationship has not been evaluated. Variable results have been reported for tilting-disc prostheses. In addition, the effect of aortic size on the Doppler-catheter gradient relationship remains unclear. METHODS: Various sizes of On-X and Edwards Mira (identical with Sorin Bicarbon) bileaflet valves and Sorin Allcarbon tilting-disc aortic valves (19-25 mm) were studied in a pulsatile flow model. Doppler and catheter gradients were measured simultaneously. Aortic diameters between 1.8 and 4 cm were evaluated. RESULTS: Correlation between Doppler and catheter gradients was excellent (r = 0.98-0.99 for peak and mean gradients), but in bileaflet valves Doppler significantly overestimated the corresponding catheter gradients as reflected by slopes of the regression lines (1.57-1.8). In the range of relevant gradients > or = 10 mmHg, Doppler exceeded catheter gradients by 40 +/- 17% (peak) and 39 +/- 16% (mean) in Mira valves, and by 46 +/- 19% (peak) and 43 +/- 14% (mean) in On-X valves. In the Sorin tilting-disc valve, Doppler accurately reflected catheter gradients (slopes of regression lines 1.05-1.14). The aortic diameter significantly influenced results in only tilting-disc valves, but in absolute terms the effect was clinically less relevant. CONCLUSION: Discrepancies between Doppler and catheter gradients are common to all bileaflet valves, regardless of their specific geometric design, whereas tilting-disc valves must be considered individually. The influence of aortic size on the Doppler-catheter gradient relationship appears clinically to be less relevant in prosthetic valves.
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