High trans-prosthetic gradients and prosthetic aortic valve dysfunction: The need for an accurate and multimodality imaging approach

Introduction: This report will review the role of echocardiography and other noninvasive methods in the differential diagnosis of high transprosthetic aortic gradients. New insights the pathophysiology of high transprosthetic gradients allowed more complete and accurate diagnosis of "functional" versus "organic" prosthetic "dysfunction indicating the strong potential of noninvasive methods. Specifically this report will review current applications of echocardiographic, Doppler and other noninvasive techniques in the evaluation of prosthetic valve mismatch and prosthetic obstruction. Moreover new insights the dynamics of discs and the Doppler characteristics of pathologic flows are discussed. Conclusions: New insights the pathophysiology of prosthetic dysfunction, prosthesis mismatch and correlated prosthetic flows have significantly improved the understanding of the more correct diagnostic approach to patients with the suspicion of prosthetic dysfunction. In this regard transthoracic and transesophageal echo and Doppler echocardiography, cinefluoroscopy and other imaging modalities have a complementary diagnostic role.