Stress echocardiography in prosthetic heart valves

As most PVs are innately and inherently stenotic, the effective orifice area (EOA) of a PV is frequently small in relation to the patient’s body size, an important phenomenon known as prosthesis/patient mismatch (PPM). In aortic valves, PPM is defined1 as moderate when the indexed EOA is ≤ 0.85 cm/m and is defined as severe when the indexed EOA is ≤ 0.65 cm/ m. In the mitral valve, the cutoff points are 1.2 and 0.9 cm/m, correspondingly. Importantly, PPM has been linked to suboptimal symptomatic improvement, weakened exercise capacity, pulmonary artery hypertension, incomplete regression of left ventricular hypertrophy, increased heart events, and even mortality rates after valve replacement (2-4) According to the literature, PPM is the most common cause of an increased transprosthetic gradient; however, it is essential to distinguish this state from other acquired PV stenoses, which may result from significant leaflet calcification on bioprosthetic valves and pannus overgrowth or thrombus creation on mechanical PVs.