Increased prosthetic valve gradients: abnormal prosthetic function or pressure recovery?

The non-invasive evaluation of prosthetic valve function is challenging. The effects of flow rate, valvular geometry, leaflet motion, and pressure recovery all impact the Doppler assessment of prosthetic performance. Differentiating prosthesis obstruction from pressure recovery in patients who are found to have high Doppler velocities across an aortic valve prosthesis is critical in order to direct appropriate management. In this manuscript, we present two cases of patients with aortic valve prosthesis with high Doppler velocities and review the pathophysiology and evaluation of prosthesis function.