Mechanical aortic valve assessment
From Echocardiography in ICU
+++ Assessment of prosthetic valves should be done by an experienced cardiologist +++
There are two types of aortic valve prosthesis: mechanical valves and tissue valves or bioprosthesis.
- Mechanical aortic valves are hyperechoic and create many artifacts, thus are difficult to evaluate
- The appearance of aortic bioprosthesis is close to the appearance of normal aortic valve. The annulus is hyperechoic and rigid compared to native structure
The criteria of assessment of aortic prosthesis are similar to those for native aortic valve:
- valve seating and motion
- regurgitation: trace regurgitation is normal (washing jets)
- thrombosis or degeneration
Parasternal long axis. Normal prosthetic aortic valve. The aortic annulus is rigid and hyperechoic compared to the aortic root.
Parasternal long axis with color on the aortic valve. There is trace aortic regurgitation (diastolic blue jet from aorta to LV). This amount of regurgitation is normal in aortic bioprosthesis
Apical 5 chamber view with color. There is an acceleration of the systolic forward flow (blue and yellow) across the aortic valve. You can see two trace aortic regurgitation (red diastolic flows), one directed toward the interventricular septum, the other toward the anterior mitral valve leaflets. These small regurgitant jets are normal.
Apical 3 chamber view, normal aortic prosthetic valve
Apical 3 chamber view with color. Like in apical 5 chamber view with color, you can see acceleration of the forward flow, and two small regurgitant flows. There is also trace mitral regurgitation.