Irving Gabriel Araújo Bispo et al. Daniela Fernanda Alli Hemerly Alberto Takeshi Kyiose Claudio Henrique Fischer Valdir Ambrosio Moises
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.
