Doppler echocardiographic assessment of the St. Jude medical prosthetic valve in the aortic position using the continuity equation

To test whether the continuity equation can be applied to the noninvasive assessment of prosthetic aortic valve function, Doppler echocardiography was performed in 67 patients (mean age, 58±14 years) within 10±6 days after valve replacement with St. Jude Medical valves. All patients were clinically stable and without evidence of valve dysfunction. Valve size ranged from 19 to 31 mm, and ejection fraction ranged from 30% to 75%. With the parasternal long-axis view, the left ventricular outflow diameter measured just proximal to the prosthetic valve correlated well with valve size (r=0.92). Doppler-derived maximal gradients ranged from 9 to 71 mm Hg. Effective prosthetic aortic valve area by the continuity equation ranged between 0.73 cm² for a 19-mm valve and 4.23 cm² for a 31-mm valve. With analysis of variance, effective orifice area differentiated various valve sizes (p<10^-14) better than did gradients alone (p=0.003) and correlated better with actual valve orifice area (r=0.83 versus -0.40). A Doppler velocity index, the ratio of peak velocity in the left ventricular outflow to that of the aortic jet, averaged 0.41±0.09 and was less dependent on valve size (r=0.43). Thus, the continuity equation can be applied to the assessment of prosthetic St. Jude valves in the aortic position. By accounting for flow through the valve, it provides an improved assessment over the sole use of gradients in the evaluation of prosthetic valve function.