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J Am Coll Cardiol, 2000; 36:1131-1141
© 2000 by the American College of Cardiology Foundation
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REVIEW ARTICLE

Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

Philippe Pibarot, DVM, PhD, FACCa and Jean G. Dumesnil, MD, FRCP(C), FACCa

a Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada

Manuscript received July 27, 1999; revised manuscript received March 27, 2000, accepted June 1, 2000.

Reprint requests and correspondence: Dr. Jean G. Dumesnil, Quebec Heart Institute, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada G1V-4G5
medjgd{at}hermes.ulaval.ca

Prosthesis–patient mismatch is present when the effective orifice area of the inserted prosthetic valve is less than that of a normal human valve. This is a frequent problem in patients undergoing aortic valve replacement, and its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of this report are to present an update on the concept of aortic prosthesis–patient mismatch and to review the present knowledge with regard to its impact on hemodynamic status, functional capacity, morbidity and mortality. Also, we propose a simple approach for the prevention and clinical management of this phenomenon because it can be largely avoided if certain simple factors are taken into consideration before the operation.

Abbreviations and Acronyms
  BSA = body surface area
  EOA = effective orifice area
  LV = left ventricular




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