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      Assessment of normal hemodynamic profile of mechanical pulmonary prosthesis by doppler echocardiography: a prospective cross-sectional study

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          Abstract

          Objectives

          Very few reports have described the Doppler-derived echocardiographic parameters for mechanical pulmonary valve prosthesis (MPVP). This study aims to describe the normal Doppler hemodynamic profile of MPVP using Doppler echocardiography.

          Methods

          The current prospective, single center observational study enrolled 108 patients who underwent pulmonary valve replacement (PVR) surgery for the first time and had a normally functioning prosthesis post-operation. The hemodynamic performance of MPVPs, considering flow dependent and flow independent parameters, was evaluated at two follow-up points, at week one and week four post-operation. All assessments were conducted by an experienced echocardiographer.

          Results

          The mean age (±SD) of the participants was 26.4 (±8.98). Tetralogy of Fallot (ToF) was the most common underlying disease leading to PVR, with a prevalence of 88%. At first week post-operation, measurement of indices reported the following values (±SD): peak pressure gradient (PPG): 18.51(±7.64) mm Hg; mean pressure gradient (MPG): 10.88(±5.62) mm Hg; peak velocity (PV): 1.97(±0.43)m/s; doppler velocity index (DVI): 0.61(±18); pulmonary velocity acceleration time (PVAT): 87.35(±15.16) ms; effective orifice area (EOA): 2.98(±1.02) cm 2;and effective orifice area to body surface area ratio (EOA/ BSA): 1.81(±0.62) cm 2/m 2. Comparing these measurements with those obtained from the second follow-up (at week four post-op) failed to hold significant difference in all values except for PVAT, which had increased from its primary value ( p = 0.038). Also, right ventricular (RV) function showed significant improvement throughout the follow up period.

          Conclusion

          The findings of this study help strengthen the previously scarce data pool and better establish the normal values for Doppler hemodynamics in mechanical pulmonary prosthesis.

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          Most cited references23

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          Prosthetic heart valves: selection of the optimal prosthesis and long-term management.

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            Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging.

            Prosthetic heart valve (PHV) dysfunction is rare but potentially life-threatening. Although often challenging, establishing the exact cause of PHV dysfunction is essential to determine the appropriate treatment strategy. In clinical practice, a comprehensive approach that integrates several parameters of valve morphology and function assessed with 2D/3D transthoracic and transoesophageal echocardiography is a key to appropriately detect and quantitate PHV dysfunction. Cinefluoroscopy, multidetector computed tomography, cardiac magnetic resonance imaging, and to a lesser extent, nuclear imaging are complementary tools for the diagnosis and management of PHV complications. The present document provides recommendations for the use of multimodality imaging in the assessment of PHVs.
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              Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades.

              Adult survivors with tetralogy of Fallot constitute a growing population with congenital heart disease. We investigated an inception cohort who underwent surgical repair. We aimed to characterize late hazard or risk for death, and determine the time-related risk of late re-operation and pulmonary valve replacement (PVR). All children (n=1181) with tetralogy of Fallot born before 1984 who underwent surgical repair at our institution were included. Follow-up (median 20 years after repair) was obtained from 2003 to 2006 via chart review, clinic consultation and telephone interview. Outcomes were analyzed using parametric and competing risks techniques with bagging. Corrective repair performed from 1960 to 1998 included transannular patch (n=370), right ventricular outflow tract patch (n=326), no patch (n=333) and right ventricular-pulmonary artery conduit (n=54). Overall, 85+/-1% survived to adulthood (age >18 years). Thirty years after repair, survival was 80+/-1%, instantaneous hazard or risk of death was 0.5+/-0.07% per year and half of survivors had undergone surgical re-operation. Surgical era of repair did not influence late risk of death. Therefore, with early surgical mortality 90% overall. The constant risk of PVR is low and independent of repair type. Baseline morphologic features are important determinants of late outcome.
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                Author and article information

                Contributors
                karimiarman74@gmail.com
                Journal
                Cardiovasc Ultrasound
                Cardiovasc Ultrasound
                Cardiovascular Ultrasound
                BioMed Central (London )
                1476-7120
                15 May 2020
                15 May 2020
                2020
                : 18
                : 14
                Affiliations
                [1 ]GRID grid.411746.1, ISNI 0000 0004 4911 7066, Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, , Iran University of Medical Sciences, ; Tehran, Iran
                [2 ]GRID grid.411746.1, ISNI 0000 0004 4911 7066, Rajaie Cardiovascular, Medical, and Research center, , Iran university of medical sciences, ; Tehran, Iran
                [3 ]GRID grid.412505.7, ISNI 0000 0004 0612 5912, Shahid Sadoughi University of Medical Sciences, ; Yazd, Iran
                [4 ]GRID grid.412505.7, ISNI 0000 0004 0612 5912, Shahid Sadoughi Hospital, , Shahid Sadoughi University of Medical Sciences, ; Yazd, Iran
                Author information
                http://orcid.org/0000-0001-6391-2371
                Article
                196
                10.1186/s12947-020-00196-0
                7229630
                32414369
                622aff1c-5df1-44ed-a074-729f8b48f798
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 25 January 2020
                : 6 May 2020
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Cardiovascular Medicine
                pulmonary mechanical prosthesis,doppler-echocardiographic,congenital heart diseases,normal hemodynamic profile

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