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Patient - prosthesis mismatch in AVR - Cardiophile MD

This case highlights a rare but potentially severe consequence of obesity in high-risk obstetric patients with previous cardiac valve replacements. The national rate of obesity in child-bearing age women continues to increase and outpace other demographics. As the obesity crisis continues, so too will the problems associated with obesity in pregnancy. As this case demonstrates, an unforeseen complication of obesity in pregnancy might occur in women with previous cardiac valve replacements. In this case, the pregnancy plus the prosthesis mismatch caused severe heart failure in a pregnant woman, severe enough to require a valve replacement during the pregnancy. Our discussion will highlight points concerning patient prosthesis mismatch and cardiopulmonary bypass surgery during pregnancy.

The impact of patient-prosthesis mismatch on late outcomes after mitral valve ..
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Patient-prosthesis mismatch (PPM) may affect clinical outcomes in patients with aortic valve replacement (AVR). We retrospectively examined the PPM in patients with isolated AVR in the Japan Adult Cardiovascular Surgery Database (JACVSD).

Prosthesis-Patient Mismatch in TAVR vs. SAVR - YouTube

23.09.2014 · Prosthesis-Patient Mismatch in TAVR vs
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Aortic root enlargement is sometimes performed to avoid the PPM, but clinical results including increased surgical risks are controversial [, ]. Newly developed prosthetic valves with smaller sewing rings and supra-annular implantation techniques contribute to avoiding the PPM. Not surprisingly, the incidence of mismatch also increases with diminishing prosthesis size, and it is widely recognized that patients with a valve size ≤21 mm tend to have much higher gradients. Nonetheless, it must be emphasized that severe mismatch can also occur in patients receiving a prosthesis size >21 mm and that, ultimately, it is always the relation between prosthesis size and body size, rather than each factor taken separately, that determines the final hemodynamic outcome [].

As the rate of obesity increases in childbearing-aged women, so too will the complications of obesity in pregnancy. An uncommon and likely underreported complication occurs in obese women who have received prepregnancy cardiac valve replacement with a prosthesis that is inadequately sized for body habitus, a condition referred to as patient-prosthesis mismatch (PPM). The physiologic changes of pregnancy as well as the increased weight gain combine to exacerbate PPM. We report a case of PPM that necessitated prosthesis replacement at 16-week gestation. As the incidence of this clinical scenario increases, it is important to understand the implications of prosthesis sizing, as well as the repercussions of having cardiopulmonary surgery to correct the undersized valve prosthesis while pregnant.

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Is patient-prosthesis mismatch an ..
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Patient-prosthesis mismatch (PPM) may affect clinical outcomes in patients with aortic valve replacement (AVR). Some clinical studies show differences in early and late outcomes in patients with PPM, but many are single-center studies. Prosthetic heart valves have a limited effective orifice area (EOA), although supra-annular type prostheses with a larger EOA are commercially available. People in the Eastern countries are physically smaller than those in the Western countries, and it is not always easy to implant a prosthetic valve of an adequate size in a smaller patient. Thus, the influence of PPM on clinical results after AVR should be clarified. We retrospectively examined PPM in patients with isolated AVR in Japan.

Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement
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