Evaluation of hemodynamic characteristics of the saint jude prosthetic heart valve in the mitral position - Nguyễn Ngọc Hoàng Mỹ

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 
6 
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 
8 
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 ≥ 
𝐶2𝑥 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 
10 
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% 
P
A
T
IE
N
T
 R
A
T
IO
 (
%
) 
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 
Our study 65 24 months 
12 
1 RESULTS - DISCUSSION 5
Structures and hemodynamic parameters of valve 
No. 
Hemodynamic 
parameters 
Mean ± SD Min - Max n 
1 Vmax (m/s) 1,78 ± 0,3 1,03 - 2,51 64 
2 Gmax (mmHg) 13,15 ± 4,18 5,65 - 25,10 63 
3 Gmean (mmHg) 4,92 ± 1,72 2,34 - 10,90 64 
4 PHT (ms) 85,39 ± 16,12 56,7 – 158,2 61 
5 EOA(PHT) (cm
2) 2,65 ± 0,44 1,39 - 3,88 61 
7 EOAI(PHT) 1,74 ± 0,36 0,99 - 2,75 61 
8 PPI(PHT) 0,71 ± 0,14 0,45 - 1,07 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 
11 EOAI(CE) 1,16 ± 0,29 0,57 - 1,92 64 
12 PPI(CE) 0,47 ± 0,12 0,26 - 0,82 64 
13 CSDT(CE) (%) 154,47 ± 15,53 129,12 - 208,53 64 
14 VTI Ratio 1,85 ± 0,49 0,95 - 3,34 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
EO
A
(C
E)
 (c
m
2
) 
1 RESULTS - DISCUSSION 5
Structures and hemodynamic parameters of valve 
PPM Frequency Percentage (%) n 
EOAI(PHT) ≤ 0,9 
cm2/m2 
0 0 61 
EOAI(PTLT) ≤ 0,9 
cm2/m2 
12 18,75 64 
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: 
• LA improved 
evidently, mostly 
in mitral valve 
regurgitation cases. 
• LDd varied 
according to types 
of mitral valve 
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 
P p(2-1) = 0,00 p(3-2) = 0,00 p(3-1) = 0,00 
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 
TT 
Hemodynamic 
parameters 
Mean ± SD 
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