Functional Evaluation of the Bileaflet Mechanical Valve in the Aortic Position Using Dobutamine-Stress Echocardiography : Is a 23-mm Prosthetic Valve Adequately Large Enough?

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The issue of valve prosthesis-patient mismatch in small annular patients is still controversial. The hemodynamic function of bileaflet mechanical valves in the aortic position was examined using dobutamine-stress echocardiography. Forty-four patients were enrolled in the study and divided into 5 groups, according to prosthesis size, from 21 mm to 29 mm. The aortic peak pressure gradient(APG)increased significantly in all groups with dobutamine-stress and exceeded 50 mmHg in 83% of the 21-mm group, in 64% of the 23-mm group, and in 33% of the 25-mm group. The APG even exceeded 80 mmHg in 22% and 18% of the 21-mm and 23-mm groups, respectively. In these cases, the potential of 'valve prosthesis-patient mismatch'was considered. From the relationship between the APG and the prosthesis valve area index(VAI), 'critical VAIs' were found where patients were likely to enter the 'mismatch' status ; that is, 1.22 and 1.77 cm^2/m^2, respectively, for the 5 and 10μg/kg per min stages of dobutamine stress. This critical VAI range is useful in predicting the 'mismatch' patients preoperatively. Alternative procedures or prostheses should then be selected for them.
社団法人日本循環器学会の論文
1998-10-20