A comprehensive evaluation of the prosthetic mitral valve includes: evaluation of the prosthetic valve leaflet movements, presence of intra and paravalvular regurgitation, peak early velocity, mean gradient, pressure half time, estimation of the pulmonary pressure, evaluation of the right and left ventricular function. Effective orifice area and Doppler velocity index are particularly essential in the evaluation of prosthetic valve stenosis.

The above media file shows turbulent flow across the prosthetic mitral valve which is suggestive of prosthetic mitral valve stenosis.

The diagnostic criteria for significant prosthetic mitral valve stenosis include:

• Mean gradient > 10 mm Hg
• Pressure half time > 200 milliseconds
• Effective orifice area = stroke volume/ VTI (prosthetic mitral valve), where VTI is velocity time integral. Effective orifice area < 1 cm2 is suggestive of significant prosthetic mitral valve stenosis.
• Doppler velocity index = VTI (prosthetic mitral valve)/ VTI (LVOT), where VTI is velocity time integral and LVOT is left ventricular outflow tract. Doppler velocity index > 2. 5 is suggestive of significant prosthetic mitral valve stenosis.

Hence the answer is option “d”.

 Reference:

1. Zoghbi WA, Jone PN, Chamsi-Pasha MA, et al. Guidelines for the evaluation of prosthetic valve function with cardiovascular imaging: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024;37:2-63.