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Non-invasive assessment of differences between bileaflet and tilting-disc aortic valve prostheses by 3D-Doppler profiles

^a University of Heidelberg Cardiac Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
^b DKFZ (German Cancer Research Centre), Med. and Biol. Informatics, Im Neuenheimer Feld 280, 69120 Heidelberg Germany
^c University of Heidelberg Department of Medical Biometry, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany

*Corresponding author. Tel.: +49/6221-56-36499 or +49/6221-56-6272; fax: +49/6221-56-5585.

E-mail address: Sibylle_Link{at}med.uni-heidelberg.de or s.link{at}dkfz.de (S. Mottl-Link).

The aim of this study was to analyse flow characteristics of two different prosthetic valves by means of a non-invasive 3D Doppler technique. As previously demonstrated, negative velocity peaks within a 3D-Doppler profile significantly correlate with the severity of aortic stenosis. Transesophageal echocardiography was performed in 42 patients with normal aortic valves and in 35 patients after aortic valve replacement (bileaflet n=23, tilting-disc n=12). Three-dimensional reconstruction of color Doppler data was performed by the EchoAnalyzer software developed at our institution. Cross-section velocity distribution in the ascending aorta was analysed 2 cm distal to the aortic valve in 3 different sectors (non-coronary (NC), left-coronary (LC) or right-coronary (RC)). The percentages of negative velocity values (PNVV) in native aortic valves (6.8±6.4%, range: 0–21.8%) were significantly lower (P<0.0001) than in prosthetic valves (bileaflet: 38.5±18.5%, range: 13.2–71%; tilting-disc: 47.2±17.6%, range: 21.7–78.1%). Significant differences between normal and prosthetic valves were found in all different sectors. Furthermore, Medtronic Hall showed significantly higher PNVV than St. Jude Medical within the LC sector (P=0.03). This method, which allows non-invasive analysis of 3D flow distributions in patients, revealed significant differences between prosthetic valves and native valves as well as among different prosthetic types.

Key Words: Prosthetic heart valves; Turbulent flow; Doppler; 3-Dimensional echocardiography