Table 10

Prosthetic Valve Dysfunction

Prosthetic Aortic Valve Stenosisa
NormalMild StenosisModerate/Severe Stenosis
Quantitative parameters (flow-dependent)
 Peak velocity (m/s)<3 m/s3–4 m/s>4 m/s
 Mean gradient (mmHg)<20 mm Hg20–40 mm Hg>40 mm Hg
Quantitative parameters (flow-independent) Doppler velocity index>0.350.35–0.25<0.25
 Effective orifice aread§>1.1 cm21.1–0.8 cm2<0.8 cm2
 Effective orifice area>0.9 cm20.9–0.6 cm2<0.6 cm2
Prosthesis-Patient Mismatch (PPM)
InsignificantModerateSevere
Indexed effective orifice area (cm2/m2)>0.85 cm2/m20.85–0.65 cm2/m2<0.65 cm2/m2
Indexed effective orifice area# (cm2/m2)>0.70 cm2/m20.90–0.60 cm2/m2<0.60 cm2/m2
Prosthetic Aortic Valve Regurgitation
MildModerateSevere
Semi-quantitative parameters
 Diastolic flow reversal in the descending aorta—PWAbsent or brief early diastolicIntermediateProminent, holodiastolic
 Circumferential extent of prosthetic valve paravalvular regurgitation (%)⁎⁎<10%10–29%≥30%
Quantitative parameters
 Regurgitant volume (mL/beat)<30 ml30–59 ml≥60 ml
 Regurgitant fraction (%)<30%30–49%≥50%
 EROA (cm2)0.10 cm20.10–0.29 cm2≥0.30 cm2

*In conditions of normal or near normal stroke volume (50–70 ml).

EROA = effective regurgitant orifice area; PW = pulsed wave.

  • These parameters are more affected by flow, including concomitant aortic regurgitation.

  • For LVOT >2.5 cm, significant stenosis criteria is <0.20.

  • § Use in setting of BSA ≥1.6 cm2 (note: dependent on the size of the valve and the size of the native annulus).

  • Use in setting of BSA <1.6 cm2.

  • Use in setting of BMI <30 kg/cm2.

  • # Use in setting of BMI ≥30 kg/cm2.

  • ⁎⁎ Not well-validated and may overestimate the severity compared with the quantitative Doppler.