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EVALUATION OF HEMODYNAMIC CHARACTERISTICS OF THE SAINT JUDE PROSTHETIC HEART VALVE IN THE MITRAL POSITION MD.. RESEARCH QUESTION 1 Rising population with Prosthetic mitral valve PrM

EVALUATION OF HEMODYNAMIC

CHARACTERISTICS OF THE SAINT JUDE

PROSTHETIC HEART VALVE

IN THE MITRAL POSITION

MD MSc NGUYỄN NGỌC HOÀNG MỸ Can Tho Central General Hospital

Thanks to

• Mentor: MD PhD Hồ Huỳnh Quang Trí

• Place of research: Heart Institute of HCM city

• Place of work: Can Tho Central General Hospital

Declaration of Interest

• No research funding

• No stocks, investments, ownership, patents

OBJECTIVE OF STUDY

2

OVERVIEW

3

METHODS

4

1 RESULTS - DISCUSSION

5

RESEARCH QUESTION

1

CONCLUSIONS

6

RECOMMENDATIONS

7

RESEARCH QUESTION

1

Rising population

with Prosthetic

mitral valve (PrMV)

PrMV: quite new area

Transthoracic echocardiogram (TTE):

useful, precise, harmless

Normal values of hemodynamic parameters of Saint Jude valve in mitral position on Doppler Echocardiography

1 Describe baseline

clinical characteristics

2 Define structure and hemodynamic parameters of PrMV on Doppler Echocardiography

3 Compare difference of basic echo parameters

in points of time

Define normal values of hemodynamic parameters of the

Saint Jude valve in mitral position

5

OBJECTIVE OF THE STUDY

2

Biological protheses: Autograft valve, Homograft valve, Xenogaft valve

Types of Prosthetic heart valves

OVERVIEW

3

Mechanical Prostheses

Monoleaflet valve Bileaflet valve Ball-cage valve

OVERVIEW

3

Methods to evaluate Prosthetic heart valves

EOA 𝑃𝐻𝑇 = 220

PHT

EOA CE = LVOT 𝑑

2 ∗ 𝜋 ∗ VTI LVOT

4 ∗ VTI MV

VTI Ratio = VTI MV

VTI(LVOT)

EOAI = EOA

BSA PPI = EOA

GOA

RESEARCH METHODS

4

Objective of study

Criteria for sample selection

• Patients with Saint Jude mitral valve replacement followed up as outpatients and in stable clinical condition

Criteria for exclusion

• Aortic stenosis or aortic regurgitation ≥ 2/4

• Aortic valve replacement

• Coronary stenosis or CABG with mitral valve replacement (MRV)

• Congenital heart defect

• Unstable clinical condition: tachycardia, angina, dyspnea, fever…

• Pleural effusion, pericardial effusion

• PrMV complication after 02 months of observation

RESEARCH METHODS

4

Research Methods

𝑛 ≥ 𝐶

2𝑥 𝑆2

𝜀2 C= 2,09 (degree of freedom 19 và p= 0,05) Sample mean 1,85 cm2

Sample variance S2= 0,12

𝑋 and  difference 5%   = 0,09

Therefore, n ≥ 61

Data Analysis

• SPSS 20.0

• Analysis of variance ANOVA, t-Test (p value<0,05)

Research design

• Prospective observation

with analysis

1 RESULTS - DISCUSSION

5

Baseline Clinical Characteristics

0%

5%

10%

15%

20%

25%

30%

35%

40%

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 3.1%

16.9%

38.5% 36.9%

4.6%

AGE GROUP

Age Mean : 46,63 ± 9,07 (22 - 63)

Female (69%), Male (31%)

58.5%

9.2%

32.3%

Mitral stenosis Mitral regurgitation Both

• Concomitant procedure of MVR: tricuspid valve repair with autologous pericardium took majority (46,15%)

• Valve size 27: 61,5%

Post surgery: 2 years on average (24,71 ±11,63 months)

Sinus rhythm (72%)

Targeted INR 38%

1 RESULTS - DISCUSSION

5

Baseline Clinical Characteristics

Author (Year) n Post Surgery

N.H.Hạnh (2005) 47 4-28 days

N.Đ.Hiền (2007) 74 Early after

L.T Phát (2007) 131 6 months

V.Q.Nga (2013) 80 12 months

Lori A Blauwet (2013) 368 < 30 days

1 RESULTS - DISCUSSION

5

Structures and hemodynamic parameters of valve

5 EOA(PHT) (cm 2 ) 2,65 ± 0,44 1,39 - 3,88 61

9 CSDT(PHT) (%) 153,64 ± 14,91 129,12 - 208,53 61

10 EOA(CE) (cm 2 ) 1,78 ± 0,43 0,80 - 2,88 64

13 CSDT(CE) (%) 154,47 ± 15,53 129,12 - 208,53 64

1.16

1.82 1.91

2.18

1.78

0.50 1.00 1.50 2.00 2.50 3.00

N.H.Hạnh (2005)

Bitar JN (1995)

Joseph F.

Malouf (2005)

Lori A.

Blauwet (2013)

Chúng tôi

2 )

1 RESULTS - DISCUSSION

5

Structures and hemodynamic parameters of valve

PPM Frequency Percentage (%) n EOAI(PHT) ≤ 0,9

EOAI(PTLT) ≤ 0,9

EOA(CE) less than EOA(PHT) (p=0,00)

1 RESULTS - DISCUSSION

5

Structures and hemodynamic parameters of valve

(PPM: Prosthesis-Patient mismatch)

Author Vũ Quỳnh Nga, Nguyễn Hồng Hạnh:

evidently, mostly

regurgitation cases

according to types

disease

• PAPs reduced slightly

No

Basic echocardiograph

y parameters

Before surgery

(1)

Pre-surgery

Early post surgery (2)

At the point of observation (3)

1 LA (mm)

Value 54,19 ± 12,33 44,94 ± 9,81 47,62 ±10,52

P p(2-1) = 0,00 p(3-2) = 0,01 p(3-1) = 0,00

2 LDd (mm)

Value 46,24 ± 7,95 44,43 ± 6,42 43,34 ± 6,75

p p(2-1) = 0,05 p(3-2) = 0,17 p(3-1) = 0,00

3 PAPs

(mmHg)

Value 53,10 ± 18,79 33,58 ± 10,24 28,02 ± 6,2

Explanation:

Obstruction of blood flow through valve removed/No

backflow from left ventricle of heart

Recovery of pulmonary capillary bed after surgery

1 RESULTS - DISCUSSION

5

Compare the basic echo parameters

between before and after valve replacement

Conclusion 1: Baseline clinical characteristics of patients with Saint Jude valve

CONCLUSION

6

1 Patients in middle age (46,63 ± 9,07), women (69%)

Good BMI: 22,22 ± 2,98

2 Mitral stenosis: most of indication Tricuspid valve repair with autologous pericardium (46,15%)

3 Valve size 27: mostly indicated 38% of the patients had INR target

Conclusion 2: Structure, hemodynamic of Saint Jude valve on Echocardiography

CONCLUSION

6

2D

• Two leaflets motion

Doppler

• Doppler waveform

• Hemodynamic parameters of

Saint Jude in mitral position

Color Echo

• Physiological regurgitation jets

1 Gmean (mmHg) 4,92 ± 1,72

2 EOA(CE) (cm 2 ) 1,78 ± 0,43

3 EOAI(CE) 1,16 ± 0,29

Conclusion 3: Compare difference of basic echo parameters in periods

CONCLUSION

6

1 Vmax, Gmax, Gmean decreased early post surgery

2 LA, Dd, PAPs significantly improved

3 Ds and EF unchanged

RECOMMENDATIONS

7

Full observations on evaluation of prosthetic valve function

Calculation of EOAI to identify patients with prosthesis-patient mismatch

Grouping patients: normal prosthesis function and prosthesis dysfunction