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NEW RECOMMENDATIONS ON HOW TO ASSESS PROSTHETIC HEART VALVES
by Guido Francesco Guida

Published on the forth of May in European Heart Journal – Cardiovascular Imaging the first recommendations on multimodality imaging assessment of prosthetic heart valves produced by the European Association of Cardiovascular Imaging (EACVI), a registered branch of the European Society of Cardiology (ESC).
Heart valve replacement is performed using mechanical or biological prostheses. It is a device implanted in the heart of a patient with valvular heart disease. When one of the four heart valves malfunctions, the medical/surgical choice may be to replace the natural valve with an artificial valve. This often requires open-heart surgery. As opposed to valve replacement by open heart nowadays can be performed
percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) that is the replacement of the aortic valve of the heart through the blood vessels. The first implantation of mechanical heart valve to human was performed by Dr. Hufnagel on September 11, 1952 using the valve that he developed.
Heart valve replacement is performed using mechanical or biological prostheses. It is estimated that by 2050, some 850 000 prosthetic heart valves will be implanted every year in western countries. Dysfunction of prosthetic heart valves is rare but can be life threatening. When it does occur, it is crucial to determine the cause as this will define what treatment is needed. The paper provides the first recommendations on how to use multimodality imaging to detect and diagnose prosthetic heart valve complications and define treatment. When prosthetic heart valve complications are suspected, the authors recommend:
First-line imaging with 2D transthoracic echocardiography (TTE)
2D and 3D TTE and transoesophageal echocardiography (TOE) for complete evaluation
🔹 Cinefluoroscopy to evaluate disc mobility and valve ring structure;
🔹 Cardiac computed tomography (CT) to visualise calcification, degeneration, pannus, thrombus;
🔹 Cardiac magnetic resonance imaging (CMR) to assess cardiac and valvular function;
🔹 Nuclear imaging, especially when infective endocarditis is suspected.
“In this paper we have underlined the incremental value of all imaging modalities to evaluate prosthetic heart valves,” said Professor Lancellotti. “Echocardiography should be used in the first instance to detect any dysfunction. Non-echo imaging modalities can be performed afterwards if more information is needed to establish the cause and extent of complications.” Professor Lancellotti concluded: “We have introduced new algorithms to help clinicians diagnose and quantify prosthetic heart valve dysfunction. They are easy to use and we hope will improve assessment and subsequent management of patients so that when complications do occur, better outcomes can be achieved.”
Picture source: numerik.math.tugraz.at
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