Echo 530

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Echo 530
2010-06-04 13:53:33

Prosthetic Valves & Other Surgical Repairs
Show Answers:

  1. The 2 types of prosthetic valves are:
    • 1. Mechanical
    • 2. Bioprosthetic
  2. Why do patients have prosthetic valves?
    • 1. When medication isn't an option
    • 2. Stenosis
    • 3. Incompetance
  3. List the 3 main components of mechanical valve with a brief definition
    • 1. Occluder - moving component (ball) - comparable to leaflets
    • 2. Restraining System - restricts motion of occluder (cage) - comparable to chordae tendinae
    • 3. Sewing Ring - attaches prosthesis to vessel - comparable to pap muscles
  4. List the 3 main mechanical valves
    • 1. Ball & Cage
    • 2. Tilting Disc
    • 3. Bi-Leaflet
  5. The most commonly used mechanical valve is __________________ because it _______________ _________________ similar to native valve.
    • Bileaflet
    • operates most
  6. What profile is a bileaflet mechanical valve?
    Low profile (not as much movement)
  7. List 2 disadcvantages for the mechanical prosthetic valves:
    • 1. Lifetime anticoagulation drugs
    • 2. Increased thromboembolic events
  8. 2 types of bioprosthetic valves are:
    • 1. Bovine
    • 2. Porcine
  9. The main disadvantage of bioprosthetic valve is ___________________________________.
    Doesn't last as long as a mechanical valve
  10. Other prosthetic devices are: (2)
    • 1. Valved Conduits
    • 2. Carpentier Ring
  11. What's a valved conduit used to repair? What material may it be? (2)
    • Some types of congenital heart disease
    • Homograft or artificial such as Gore-Tex or Dacron
  12. Carpentier Ring is used to repair_______________________. (Durand)
    What is a carpentier ring and how is it used?
    What does it resemble?
    AV valves

    Flexible ring that's sewn into annulus to help support the native ring.

    Resembles MAC
  13. Define: Pannus Formation
    Fibrous ingrowth of tissue
  14. Define Dehiscence
    Sutures of sewing ring loosen
  15. List complications of a mechanical & bioprosthetic valves seen on an echocardiogram: (8) PATTD CH

    Which ones are specific to bio vs. mech?
    • Thrombus
    • Pannus
    • Turbulent Flow
    • Dehiscence
    • Abscess Formation
    • Mechanical failure
    • Calcification or degeneration of valve (bioprosthetic)
    • Hemolysis - RBC damaged as passing through mechanical valve
  16. Can you tell the difference of Pannus due to endocarditis vs thrombus formation?
  17. All prosthetic valves have higher velocities. Why? T/F
    • True
    • Smaller orifice area
  18. What does high profile mean? Low profile?
    • High = lots of movement Ie: ball & cage
    • Low = little motion Ie: bileaflet
  19. Explain the difference in flow pattern of a prosthetic mitral valve vs a normal MV. Think of the picture you drew.
    • Normal flow moves from MV to apex, curves and heads to AO valve.
    • Prosthetic is directed toward mid LV anterior wall and then heads out AO valve. Done to avoid thrombus formation
  20. Doppler of mechanical valves demonstrates valve click. What is valve click, and how can one use this to help with Dx of stenosis?
    • Valve click = opening + closing of valve
    • Stenosis = higher velocities than expected
  21. With prosthetic valves the smaller orifice the _________________________ the velocity.
  22. What is the MC brand of mechanical valve?
    Star Edwards
  23. What type of low profile mechanical valve is no longer used?
    Bjork Shiley
  24. A problem with mechanical valves is ___________________ PG.
  25. MC bileaflet mechanical valve is ________________________.
    St. Jude
  26. What is the MC mechanical valve used?
    Bileaflet tilting disc; St. Jude
  27. Define: Heterograft (Xenograft)
    mace from porcine or bovine tissue (animal)
  28. Define: Homograft
    AO valves harvested @ autopsy or dura mater
  29. Define: Autograft
    Patients own tissue (fascia lata, fibrous mmb from thigh muscle)
  30. What is the name of the procedure when using an autograft?
    Ross Procedure
  31. Name the 3 main components of Bioprosthetic valves:
    • 1. Mobile part - constructed of tissue (semilunar valves from pigs, cows or humans)
    • 2. Restraining system - stents or struts
    • 3. Sewing Ring
  32. What is a disadvantage of using bioprosthetic valves?
    Not as long lasting
  33. Why would a Dr. choose a mechanical or bioprosthetic valve?
    • Mechanical:
    • 1. Young
    • 2. Renal failure, small valve annulus, high reop risk
    • 3. AO root replacement - dissection with severe AI

    • Bioprosthetic:
    • 1. Elderly
    • 2. Chronic anticoag not advised
    • 3. High risk of thromboembolism
  34. All prosthetic valves are inherintly _______________________.
  35. Larger valve areas have _________________ velocities and PG and _________________ EOA.
    • lower
    • larger
  36. Why when you have a smaller EOA with a higher velocity would the mean PG be lower even though PG is higher?
    Less area to trace. Sawtooth shape
  37. Is prosthetic regurg normal?
  38. Name some limitations of prosthetic valves: (4 multi points)
    • 1. reverberation, artifact, acoustic shadowing
    • 2. Overestimation of transvalvular PG with bileaflet mechanical valves
    • 3. Differentiating normal from pathologic prosthetic valve regurgitation
    • 4. Detection of valvular vegetations is difficult d/t reverberations
  39. What always accompanies a vegetation?
  40. Whenever you have open heart surgery, expect to see :
    paradoxical septal motion
  41. Why does PISA work well on prosthetic valves?
    Because of the forward flow
  42. What is the MC cardiac trauma?
  43. Stented bioprosthetic valves have an appearance similar to ______________________________.
    Native AO valve
  44. Bioprosthetic valve longevity
  45. Why is the apical view not useful when assessing MR or mechanical prosthetic valve?
    acoustic shadowing