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CARDIOVASCULAR ANESTHESIA

Is the Valve OK or Not? Immediate Evaluation of a Replaced Aortic Valve

Department of Anesthesiology Durham Veterans Medical Center Duke University School of Medicine Durham, North Carolina

Address correspondence and reprint requests to Rebecca A. Schroeder, MD, Department of Anesthesiology Durham Veterans Medical Center Duke University School of Medicine VAMC (112C), 508 Fulton St. Durham, NC 27705. Address electronic mail to schro016{at}mc.duke.edu.

Transesophageal echocardiography is a crucial tool in intraoperative evaluation of newly implanted/repaired heart valves because suspected valvular malfunction needs to be identified and sometimes surgically corrected. Although color Doppler is often adequate in evaluating the expected regurgitant jets, as well as excluding pathologic paravalvular leaks, spectral Doppler techniques are the most commonly used methods for estimating transvalvular gradients in the operating room. However, these methods are subject to a variety of confounding factors, including subvalvular gradients and pressure recovery. Other methods of valve area estimation should also be used when evaluating a prostethic aortic valve, including the continuity equation and the left ventricular outflow tract/aortic valve velocity ratio.