Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography

Quebec Heart Institute, Laval University, Sainte-Foy, Canada.

Doppler echocardiographic evaluation of aortic valve prostheses is based on the use of variables heretofore validated mostly for native valves. Accordingly, this study examined the validity and relative usefulness of the Doppler valve gradient and area measurements in 31 patients (mean age 69 +/- 10 years) 20 +/- 4 months after implantation of a given type of aortic bioprosthesis ranging in size from 19 to 29 mm. Valve area data obtained with both the standard and simplified continuity equations were compared with known in vitro prosthetic valve area measurements and an excellent correlation was obtained between the standard and simplified continuity equations (r = 0.98, SEE +/- 0.07 cm2, p less than 0.0005) and between in vivo and known in vitro prosthetic valve areas (r = 0.86, SEE +/- 0.16 cm2, p less than 0.0005). Peak gradient ranged from 10.8 to 75.0 mm Hg (mean 35 +/- 16) and mean gradient from 7.6 to 43.7 mm Hg (mean 20.5 +/- 9.5). The correlations between prosthetic valve gradient and in vivo area were r = -0.53, SEE +/- 14 mm Hg and r = -0.49, SEE +/- 8.63 mm Hg for peak and mean gradient, respectively. These relations were improved by indexing valve area by body surface area. The best correlations were obtained between indexed valve area and a quadratic function of the gradient (r = -0.72, SEE +/- 11.72 mm Hg and r = -0.70, SEE +/- 7.28 mm Hg for peak and mean gradient, respectively), reflecting a curvilinear relation.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				S. Spethmann, H. Dreger, S. Schattke, G. Baldenhofer, D. Saghabalyan, V. Stangl, M. Laule, G. Baumann, K. Stangl, and F. Knebel Doppler haemodynamics and effective orifice areas of Edwards SAPIEN and CoreValve transcatheter aortic valves Eur Heart J Cardiovasc Imaging, February 3, 2012; (2012) jes021v1. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Doppler echocardiographic evaluation of prosthetic valve function Heart, January 1, 2012; 98(1): 69 - 78. [Full Text] [PDF]

				D. Kalavrouziotis, J. Rodes-Cabau, R. Bagur, D. Doyle, R. De Larochelliere, P. Pibarot, and E. Dumont Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus J. Am. Coll. Cardiol., August 30, 2011; 58(10): 1016 - 1024. [Abstract] [Full Text] [PDF]

				Q. Zhong, Y. Xiao, J. Chen, and R. Ma Strategy of Aortic Root Enlargement in Patients Undergoing Aortic and Mitral Valve Replacement Ann. Thorac. Surg., September 1, 2010; 90(3): 782 - 787. [Abstract] [Full Text] [PDF]

				Y. Sakamoto, M. Yoshitake, H. Naganuma, N. Kawada, K. Kinouchi, and K. Hashimoto Reconsideration of Patient-Prosthesis Mismatch Definition From the Valve Indexed Effective Orifice Area Ann. Thorac. Surg., June 1, 2010; 89(6): 1951 - 1955. [Abstract] [Full Text] [PDF]

				N. J. Howell, B. E. Keogh, D. Ray, R. S. Bonser, T. R. Graham, J. Mascaro, S. J. Rooney, I. C. Wilson, and D. Pagano Patient-Prosthesis Mismatch in Patients With Aortic Stenosis Undergoing Isolated Aortic Valve Replacement Does Not Affect Survival Ann. Thorac. Surg., January 1, 2010; 89(1): 60 - 64. [Abstract] [Full Text] [PDF]

				R. M. Suri, K. J. Zehr, T. M. Sundt III, J. A. Dearani, R. C. Daly, J. K. Oh, and H. V. Schaff Left Ventricular Mass Regression After Porcine Versus Bovine Aortic Valve Replacement: A Randomized Comparison Ann. Thorac. Surg., October 1, 2009; 88(4): 1232 - 1237. [Abstract] [Full Text] [PDF]

				P. Cattaneo, M. Baravelli, A. Rossi, G. Mariscalco, M. Romano, D. Imperiale, A. Bregasi, and C. Anza Ejection Fraction/Velocity Ratio Identifies Prosthesis-Patient Mismatches in Patients With Aortic Bioprosthetic Valves and Left Ventricular Dysfunction J. Ultrasound Med., September 1, 2009; 28(9): 1167 - 1174. [Abstract] [Full Text] [PDF]

				M. Akhtar, E. M. Tuzcu, S. R. Kapadia, L. G. Svensson, R. K. Greenberg, E. E. Roselli, S. Halliburton, V. Kurra, P. Schoenhagen, and S. Sola Aortic root morphology in patients undergoing percutaneous aortic valve replacement: Evidence of aortic root remodeling J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 950 - 956. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management Circulation, February 24, 2009; 119(7): 1034 - 1048. [Full Text] [PDF]

				D. Mohty, J. G. Dumesnil, N. Echahidi, P. Mathieu, F. Dagenais, P. Voisine, and P. Pibarot Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular Dysfunction J. Am. Coll. Cardiol., January 6, 2009; 53(1): 39 - 47. [Abstract] [Full Text] [PDF]

				M. Vicchio, A. Della Corte, L. S. De Santo, M. De Feo, G. Caianiello, M. Scardone, and M. Cotrufo Prosthesis-Patient Mismatch in the Elderly: Survival, Ventricular Mass Regression, and Quality of Life Ann. Thorac. Surg., December 1, 2008; 86(6): 1791 - 1797. [Abstract] [Full Text] [PDF]

				D. Tanne, L. Kadem, R. Rieu, and P. Pibarot Hemodynamic impact of mitral prosthesis-patient mismatch on pulmonary hypertension: an in silico study J Appl Physiol, December 1, 2008; 105(6): 1916 - 1926. [Abstract] [Full Text] [PDF]

				J. B. Chambers, R. Rajani, D. Parkin, H. M. Rimington, C. I. Blauth, G. E. Venn, C. P. Young, and J. C. Roxburgh Bovine pericardial versus porcine stented replacement aortic valves: Early results of a randomized comparison of the Perimount and the Mosaic valves. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1142 - 1148. [Abstract] [Full Text] [PDF]

				A. Kulik, M. Al-Saigh, V. Chan, R. G. Masters, P. Bedard, B.-K. Lam, F. D. Rubens, P. J. Hendry, T. G. Mesana, and M. Ruel Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit? Ann. Thorac. Surg., January 1, 2008; 85(1): 94 - 100. [Abstract] [Full Text] [PDF]

				G. M. Feuchtner, S. Muller, J. Bonatti, T. Schachner, C. Velik-Salchner, O. Pachinger, and W. Dichtl Sixty-Four Slice CT Evaluation of Aortic Stenosis Using Planimetry of the Aortic Valve Area Am. J. Roentgenol., July 1, 2007; 189(1): 197 - 203. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Prosthesis-patient mismatch in the mitral position: Old concept, new evidences J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1405 - 1408. [Full Text] [PDF]

				P. Pibarot and J. G Dumesnil Prevention of valve prosthesis--patient mismatch before aortic valve replacement: does it matter and is it feasible? Heart, May 1, 2007; 93(5): 549 - 551. [Abstract] [Full Text] [PDF]

				C. R. Bridges, S. M. O'Brien, J. C. Cleveland, E. B. Savage, J. S. Gammie, F. H. Edwards, E. D. Peterson, and F. L. Grover Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1012 - 1021. [Abstract] [Full Text] [PDF]

				W. Flameng, B. Meuris, P. Herijgers, and M.-C. Herregods Prosthesis-Patient Mismatch is Not Clinically Relevant in Aortic Valve Replacement Using the Carpentier-Edwards Perimount Valve Ann. Thorac. Surg., August 1, 2006; 82(2): 530 - 536. [Abstract] [Full Text] [PDF]

				P Pibarot and J G Dumesnil Prosthesis-patient mismatch: definition, clinical impact, and prevention Heart, August 1, 2006; 92(8): 1022 - 1029. [Abstract] [Full Text] [PDF]

				N. J. Howell, B. E. Keogh, V. Barnet, R. S. Bonser, T. R. Graham, S. J. Rooney, I. C. Wilson, and D. Pagano Patient-prosthesis mismatch does not affect survival following aortic valve replacement Eur J Cardiothorac Surg, July 1, 2006; 30(1): 10 - 14. [Full Text] [PDF]

				J. G. Dumesnil and P. Pibarot Prosthesis-patient mismatch and clinical outcomes: The evidence continues to accumulate J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 952 - 955. [Full Text] [PDF]

				G. M. Feuchtner, W. Dichtl, G. J. Friedrich, M. Frick, H. Alber, T. Schachner, J. Bonatti, A. Mallouhi, T. Frede, O. Pachinger, et al. Multislice Computed Tomography for Detection of Patients With Aortic Valve Stenosis and Quantification of Severity J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1410 - 1417. [Abstract] [Full Text] [PDF]

				Y. Sakamoto, K. Hashimoto, H. Okuyama, H. Takakura, S. Ishii, S. Taguchi, and H. Kagawa Prevalence and Avoidance of Patient-Prosthesis Mismatch in Aortic Valve Replacement in Small Adults Ann. Thorac. Surg., April 1, 2006; 81(4): 1305 - 1309. [Abstract] [Full Text] [PDF]

				A. Roscitano, U. Benedetto, A. Sciangula, E. Merico, F. Barberi, R. Bianchini, E. Tonelli, and R. Sinatra Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly Eur J Cardiothorac Surg, February 1, 2006; 29(2): 139 - 143. [Abstract] [Full Text] [PDF]

				G. Tasca, Z. Mhagna, S. Perotti, P. B. Centurini, T. Sabatini, A. Amaducci, F. Brunelli, M. Cirillo, M. D. Tomba, E. Quiani, et al. Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis Circulation, January 31, 2006; 113(4): 570 - 576. [Abstract] [Full Text] [PDF]

				P. Totaro, N. Degno, A. Zaidi, A. Youhana, and V. Argano Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance? J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1668 - 1674. [Abstract] [Full Text] [PDF]

				F. Botzenhardt, W. B. Eichinger, S. Bleiziffer, R. Guenzinger, I. M. Wagner, R. Bauernschmitt, and R. Lange Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic Annulus J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2054 - 2060. [Abstract] [Full Text] [PDF]

				A. Penta de Peppo, J. Zeitani, P. Nardi, G. Iaci, P. Polisca, R. De Paulis, and L. Chiariello Small "Functional" Size after Mechanical Aortic Valve Replacement: No Risk in Young to Middle-Age Patients Ann. Thorac. Surg., June 1, 2005; 79(6): 1915 - 1920. [Abstract] [Full Text] [PDF]

				M. Li, J. G. Dumesnil, P. Mathieu, and P. Pibarot Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1034 - 1040. [Abstract] [Full Text] [PDF]

				G. Tasca, F. Brunelli, M. Cirillo, M. Dalla Tomba, Z. Mhagna, G. Troise, and E. Quaini Impact of the Improvement of Valve Area Achieved With Aortic Valve Replacement on the Regression of Left Ventricular Hypertrophy in Patients With Pure Aortic Stenosis Ann. Thorac. Surg., April 1, 2005; 79(4): 1291 - 1296. [Abstract] [Full Text] [PDF]

				G. Tasca, F. Brunelli, M. Cirillo, M. DallaTomba, Z. Mhagna, G. Troise, and E. Quaini Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement Ann. Thorac. Surg., February 1, 2005; 79(2): 505 - 510. [Abstract] [Full Text] [PDF]

				G. Tasca, F. Brunelli, M. Cirillo, A. Amaducci, Z. Mhagna, G. Troise, and E. Quaini Mass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesis Ann. Thorac. Surg., October 1, 2003; 76(4): 1107 - 1113. [Abstract] [Full Text] [PDF]

				E. H. Blackstone, D. M. Cosgrove, W.R. E. Jamieson, N. J. Birkmeyer, J. H. Lemmer Jr, D. C. Miller, E. G. Butchart, G. Rizzoli, M. Yacoub, and A. Chai Prosthesis size and long-term survival after aortic valve replacement J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 783 - 793. [Abstract] [Full Text] [PDF]

				C. Blais, J. G. Dumesnil, R. Baillot, S. Simard, D. Doyle, and P. Pibarot Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement Circulation, August 26, 2003; 108(8): 983 - 988. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, E. H. Blackstone, and L. L. Rodriguez Prosthesis-patient size: measurement and clinical implications J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 313 - 316. [Full Text] [PDF]

				S. Bevilacqua, J. Gianetti, A. Ripoli, U. Paradossi, A. Giuseppe Cerillo, M. Glauber, M. L. Sacha Matteucci, M. Senni, A. Gamba, E. Quaini, et al. Aortic valve disease with severe ventricular dysfunction: stentless valve for better recovery Ann. Thorac. Surg., December 1, 2002; 74(6): 2016 - 2021. [Abstract] [Full Text] [PDF]

				H. Niinami, S. Aomi, H. Tomioka, K. Nakano, and H. Koyanagi A comparison of the in vivo performance of the 19-mm St. Jude medical hemodynamic plus and 21-mm standard valve Ann. Thorac. Surg., October 1, 2002; 74(4): 1120 - 1124. [Abstract] [Full Text] [PDF]

				L. J. Castro, J. M. Arcidi Jr, A. L. Fisher, and V. A. Gaudiani Routine enlargement of the small aortic root: a preventive strategy to minimize mismatch Ann. Thorac. Surg., July 1, 2002; 74(1): 31 - 36. [Abstract] [Full Text] [PDF]

				S. Gelsomino, G. Morocutti, R. Frassani, P. Da Col, R. Carella, and U. Livi Usefulness of the cryolife o'brien stentless suprannular aortic valve to prevent prosthesis-patient mismatch in the small aortic root J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1845 - 1851. [Abstract] [Full Text] [PDF]

				A. D. Milano, M. De Carlo, G. Mecozzi, A. D'Alfonso, G. Scioti, C. Nardi, and U. Bortolotti Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-up Ann. Thorac. Surg., January 1, 2002; 73(1): 37 - 43. [Abstract] [Full Text] [PDF]

				N. Vitale, I. Caldarera, C. Muneretto, R. Sinatra, A. Scafuri, E. Di Rosa, A. Contini, N. Tedesco, A. Pierangeli, M. Abbate, et al. Clinical evaluation of St Jude Medical Hemodynamic Plus versus standard aortic valve prostheses: The Italian multicenter, prospective, randomized study J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 691 - 698. [Abstract] [Full Text] [PDF]

				I. Kadir, I. Y.P. Wan, C. Walsh, P. Wilde, A. J. Bryan, and G. D. Angelini Hemodynamic performance of the 21-mm Sorin Bicarbon mechanical aortic prostheses using dobutamine Doppler echocardiography Ann. Thorac. Surg., July 1, 2001; 72(1): 49 - 53. [Abstract] [Full Text] [PDF]

				I. Knez, R. RienmullerRienmuller, R. Maier, P. Rehak, B. SchrottnerSchrottner, H. MachlerMachler, M. Anelli-Monti, and B. Rigler Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch? Eur J Cardiothorac Surg, June 1, 2001; 19(6): 797 - 805. [Abstract] [Full Text] [PDF]

				S. E. Girard, F. A. Miller Jr., T. A. Orszulak, C. J. Mullany, S. Montgomery, W. D. Edwards, H. D. Tazelaar, J. F. Malouf, and A. J. Tajik Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings J. Am. Coll. Cardiol., February 1, 2001; 37(2): 579 - 584. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G. Dumesnil Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1131 - 1141. [Abstract] [Full Text] [PDF]

				A. D. Maslow, J. M. Haering, S. Heindel, J. Mashikian, R. Levine, and P. Douglas An Evaluation of Prosthetic Aortic Valves Using Transesophageal Echocardiography: The Double-Envelope Technique Anesth. Analg., September 1, 2000; 91(3): 509 - 516. [Abstract] [Full Text] [PDF]

				D. Garcia, P. Pibarot, J. G. Dumesnil, F. Sakr, and L.-G. Durand Assessment of Aortic Valve Stenosis Severity : A New Index Based on the Energy Loss Concept Circulation, February 22, 2000; 101(7): 765 - 771. [Abstract] [Full Text] [PDF]

				P. Pibarot, J. G. Dumesnil, J. Jobin, P. Cartier, G. Honos, and L.-G. Durand Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve: Comparison of stentless versus stented bioprostheses J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1609 - 1617. [Abstract] [Full Text] [PDF]

				M. B. Izzat, I. Kadir, B. Reeves, P. Wilde, A. J. Bryan, and G. D. Angelini Patient-prosthesis mismatch is negligible with modern small-size aortic valve prostheses Ann. Thorac. Surg., November 1, 1999; 68(5): 1657 - 1660. [Abstract] [Full Text] [PDF]

				O. Bech-Hanssen, K. Caidahl, B. Wall, P. Myken, S. Larsson, and I. Wallentin INFLUENCE OF AORTIC VALVE REPLACEMENT, PROSTHESIS TYPE, AND SIZEON FUNCTIONAL OUTCOME AND VENTRICULAR MASS IN PATIENTS WITH AORTIC STENOSIS J. Thorac. Cardiovasc. Surg., July 1, 1999; 118(1): 57 - 65. [Abstract] [Full Text] [PDF]

				P. C. Cartier, J. G. Dumesnil, J. Metras, D. Desaulniers, D. P. Doyle, M. D. Lemieux, and G. Raymond Clinical and hemodynamic performance of the freestyle aortic root bioprosthesis Ann. Thorac. Surg., February 1, 1999; 67(2): 345 - 349. [Abstract] [Full Text] [PDF]

				U. Hvass, G. M. Palatianos, R. Frassani, C. Puricelli, and M. O'Brien MULTICENTER STUDY OF STENTLESS VALVE REPLACEMENT IN THE SMALL AORTIC ROOT J. Thorac. Cardiovasc. Surg., February 1, 1999; 117(2): 267 - 272. [Abstract] [Full Text] [PDF]

				X. Y. Jin, K. Dhital, K. Bhattacharya, R. Pieris, N. Amarasena, and R. Pillai Fifth-year hemodynamic performance of the prima stentless aortic valve Ann. Thorac. Surg., September 1, 1998; 66(3): 805 - 809. [Abstract] [Full Text] [PDF]

				N. Cam, H. Gercekoglu, S. Celik, M. Gursurer, G. Tayyareci, H. Karabulut, A. Narin, T. Tezel, and B. Yigiter Dobutamine Stress Test to Evaluate Different Sizes of Prosthetic Aortic Valves Asian Cardiovasc Thorac Ann, September 1, 1998; 6(3): 166 - 173. [Abstract] [Full Text] [PDF]

				U. Demirkilic, E. Kuralay, E. Ozal, H. Bingol, C. Sag, A. T Yilmaz, and H. Tatar Medium-Term Outcome With Small Size ATS Medical Valves in Aortic Position Asian Cardiovasc Thorac Ann, September 1, 1998; 6(3): 183 - 187. [Abstract] [Full Text] [PDF]

				B. Chakraborty, S. Quek, Ding Zee Pin, Chee Tek Siong, Tan Ley Kheng, and B. Chakraborty Evaluation of Normal Hemodynamic Profile of Carbomedics Prosthetic Valves by Doppler Echocardiography Angiology, December 1, 1997; 48(12): 1055 - 1061. [Abstract] [PDF]

				T. E. David, J. Kuo, and S. Armstrong AORTIC AND MITRAL VALVE REPLACEMENT WITH RECONSTRUCTION OF THE INTERVALVULAR FIBROUS BODY J. Thorac. Cardiovasc. Surg., November 1, 1997; 114(5): 766 - 772. [Abstract] [Full Text]

				K. E. Sommers and T. E. David Aortic Valve Replacement With Patch Enlargement of the Aortic Annulus Ann. Thorac. Surg., June 1, 1997; 63(6): 1608 - 1612. [Abstract] [Full Text]

				R. De Paulis, L. Sommariva, G. M. De Matteis, E. Caprara, F. Tomai, A. P. de Peppo, P. Polisca, C. Bassano, and L. Chiariello EXTENT AND PATTERN OF REGRESSION OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH SMALL SIZE CARBOMEDICS AORTIC VALVES J. Thorac. Cardiovasc. Surg., May 1, 1997; 113(5): 901 - 909. [Abstract] [Full Text]

				I. Kadir, M. B. Izzat, P. Wilde, B. Reeves, A. J. Bryan, and G. D. Angelini Dynamic Evaluation of the 21-mm Medtronic Intact Aortic Bioprosthesis by Dobutamine Echocardiography Ann. Thorac. Surg., April 1, 1997; 63(4): 1128 - 1132. [Abstract] [Full Text]

				M. L. McDonald, R. C. Daly, H. V. Schaff, C. J. Mullany, F. A. Miller, J. J. Morris, and T. A. Orszulak Hemodynamic Performance of Small Aortic Valve Bioprostheses: Is There a Difference? Ann. Thorac. Surg., February 1, 1997; 63(2): 362 - 366. [Abstract] [Full Text]

				B. Chakraborty, S. Quek, Ding Zee Pin, Chee Tek Siong, and Tan Lay Kheng Doppler Echocardiographic Assessment of Normally Functioning Starr-Edwards, Carbomedics and Carpentier-Edwards Valves in Aortic Position Angiology, May 1, 1996; 47(5): 481 - 489. [Abstract] [PDF]

				T. Carrel, U. Zingg, R. Jenni, B. Aeschbacher, and M. I. Turina Early In Vivo Experience With the Hemodynamic Plus St. Jude Medical Heart Valves in Patients With Narrowed Aortic Annulus Ann. Thorac. Surg., May 1, 1996; 61(5): 1418 - 1422. [Abstract] [Full Text]

				M. B. Izzat, I. Birdi, P. Wilde, A. J. Bryan, and G. D. Angelini COMPARISON OF HEMODYNAMIC PERFORMANCES OF ST. JUDE MEDICAL AND CARBOMEDICS 21 MM AORTIC PROSTHESES BY MEANS OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 408 - 415. [Abstract] [Full Text]

				M. B. Izzat, I. Birdi, P. Wilde, A. J. Bryan, and G. D. Angelini Evaluation of the hemodynamic performance of small carbomedics aortic prosthesis using dobutamine-stress doppler echocardiography Ann. Thorac. Surg., October 1, 1995; 60(4): 1048 - 1052. [Abstract] [PDF]

				R. De Paulis, L. Sommariva, F. Russo, F. Tomai, A. Tondo, C. Pagliaricci, C. Bassano, and L. Chiariello Doppler echocardiography evaluation of the CarboMedics valve in patients with small aortic anulus and valve prosthesis-body surface area mismatch J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 57 - 62. [Abstract] [Full Text]

				E. G. Cape, W. Jaarsma, and A. P. Yoganathan Echo Doppler principles, techniques and applications for the cardiac surgeon Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S2 - S12. [Abstract] [PDF]

				J. G. Dumesnil and A. P. Yoganathan Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradients Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S34 - S38. [Abstract] [PDF]

				B. G. Barratt-Boyes Clinical experience with the zero-pressure-fixed Medtronic Intact bioprosthetic valve Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S79 - S81. [Abstract] [PDF]

				F. Vermeulen, G. Bennink, S. Ernst, W. Jaarsma, P. A. Chevalier, and D. V. Lutz The intact porcine bioprosthesis: early world-wide clinical experience and analysis of a single institution's experience Eur J Cardiothorac Surg, January 1, 1992; 6(Supplement_1): S124 - S127. [Abstract] [PDF]