Arq Bras Cardiol: Imagem cardiovasc. 2023; 36(4): e20230054

Clinical and Echocardiographic Aspects of Patient-Prosthesis Mismatch in Patients With Prosthetic Aortic Valves

Irving Gabriel Araújo

Bispo

, Daniela Fernanda Alli

Hemerly

, Alberto Takeshi

Kyiose

, Claudio Henrique

Fischer

, Valdir Ambrosio

Moises

DOI: 10.36660/abcimg.20230054i

Abstract

Introduction:

Patient-prosthesis mismatch (PPM) is considered to occur if a prosthetic heart valve has a high transvalvular pressure gradient and a reduced indexed valve area, despite normally functioning discs. PPM may have clinical and hemodynamic repercussions for patients.

Objective:

To analyze the clinical and echocardiographic characteristics of PPM in patients with prosthetic aortic valves.

Methods:

Patients aged 18 years or over with a biological or mechanical aortic valve undergoing follow-up since February 2010 were included. PPM was considered mild if the indexed valve area was ≥ 0.85 cm²/m² and severe if ≤ 0.65 cm²/m². Variables were compared between groups with moderate or severe PPM (PPMAO2) and mild PPM (PPMAO1); significant if p<0.05.

Results:

Sixty patients (36 women) with prosthetic aortic valves (29 biological and 31 mechanical) were included. PPMAO2 was diagnosed in 12 patients (20%), who had a mean valve area of 0.66 cm²/m² and mean gradient of 24 mm Hg. Functional class II or III was more frequent in the PPMAO2 group (66.7%) than in the PPMAO1 group (20.8%); p<0.001. Left atrial volume (51 ± 16 mL/m² x 40 ± 12 mL/m²; p=0.002) and left ventricular septal and wall thicknesses (10.83 mm x 10 mm; p=0.018) were higher in the PPMAO2 group.

Conclusions:

Moderate or severe PPM occurred in 20% of patients. These patients were more symptomatic and had higher left atrial volumes and left ventricular myocardial wall thickness.