To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement.

The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 (12-40) months. The postoperative effective orifice area (EOA) of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results: measured EOA=referred EOA and measured EOA<referred EOA. If the measured EOA=referred EOA, the effective orifice area index (EOAI) was calculated according to the artificial valve referred EOA and body surface area (BSA), and EOAI was divided into EOAI>0.85 cm²/m² and EOAI<0.85 cm²/m². The reasons of high transprothetic pressure gradient were analyzed according to the above different standard.

In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis- patient mismatch (PPM) was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus (3 cases improved after increasing the dosage of warfarin, 2 cases underwent re- aortic valve replacement), 3 cases were because of severe bioprosthetic calcification (underwent re- aortic valve replacement), and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets (underwent re- aortic valve replacement). High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac.

Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

Heart valve diseases; Heart valve prosthesis; Retrospective studies