Patient Prosthetic Mismatch

[Denise1]

I was wondering if there are others with prosthetic mismatch and any symptoms you may have.

 

[Seaton]

I was wondering if there are others with prosthetic mismatch and any symptoms you may have.

Hello Denise

@Paleowoman has patient prosthesis mismatch and is currently being monitored.

I am sure she’ll comment on here soon with more details.

Best to you.

 

[Paleowoman]

Here I am !

Yes, I’ve got moderate patient prosthesis mismatch. My main symptoms are that I never got back to the level of fitness and strength I had prior to aortic valve replacement. My pressure gradients were quite high immediately post surgery and have steadily risen - last year when the valve was four years old the peak gradient was 58mmHg and the mean gradient 31mmHg. The "indexed effective orifice area" of the valve is 0.75cm2/m2. I have annual echos, sometimes six monthlies too. My next echo is next week.The valve has been checked thoroughly with a transoesophageal echo to see if it’s damaged - it isn’t, it’s just small. It has been explained to me by another cardiac surgeon, not the one that did my surgery, that the place where the replacement valve is implanted cannot take a bigger valve than the actual space which is measured with a “sizer” during surgery in the operating theatre. A bigger valve can be implanted supra-annually (I’ve no idea why that wasn’t considered for me).

What are your symptoms Denise ?

 

[tom in MO]

You might want to change your thread title. PPM means parts per million in my world or planned preventive maintenance.

 

[Paleowoman]

When it comes to valve surgery PPM stands for patient prosthesis mismatch. Articles about it will often use the abbreviation PPM.
I just found a whole list of medical abbreviations which are PPM: https://www.allacronyms.com/_medical/PPM !

 

[Paleowoman]

It might be a good idea to change the title of the thread to Patient Prosthesis Mismatch as then people would have more of an idea of what the thread was about at a glance. However can titles of threads be changed ? They couldn't on the 'old' forum.

 

[Denise1]

Here I am !

Yes, I’ve got moderate patient prosthesis mismatch. My main symptoms are that I never got back to the level of fitness and strength I had prior to aortic valve replacement. My pressure gradients were quite high immediately post surgery and have steadily risen - last year when the valve was four years old the peak gradient was 58mmHg and the mean gradient 31mmHg. The "indexed effective orifice area" of the valve is 0.75cm2/m2. I have annual echos, sometimes six monthlies too. My next echo is next week.The valve has been checked thoroughly with a transoesophageal echo to see if it’s damaged - it isn’t, it’s just small. It has been explained to me by another cardiac surgeon, not the one that did my surgery, that the place where the replacement valve is implanted cannot take a bigger valve than the actual space which is measured with a “sizer” during surgery in the operating theatre. A bigger valve can be implanted supra-annually (I’ve no idea why that wasn’t considered for me).

What are your symptoms Denise ?

I've had fatigue and memory loss since the last valve replacement . I was born with aortic stenosis and had my first valve surgery when I was 8. Three more valve surgeries after that for a total of 4. I have a 17 mm St Jude valve and my surgeon also told me that was the only one he could fit. I think it's the smallest one they make. Do you know how common this issue is?

 

[Denise1]

You might want to change your thread title. PPM means parts per million in my world or planned preventive maintenance.

Thanks lol, I changed it

 

[Paleowoman]

I have a 17 mm St Jude valve and my surgeon also told me that was the only one he could fit. I think it's the smallest one they make. Do you know how common this issue is?

Hi @Denise1

I don’t know how common PPM is, there’s only ever been one other person apart from me, and now you, on forum with PPM as far as I know. There's a lot about it on the internet. I emailed one of the cardiologists who has written several papers on it: Dr Philippe Pibarot (do a search with Philippe Pibarot PPM and you will get lots of hits). Dr Pibarot very kindly replied to my email - he was able to tell just from my weight, height and replacement valve make and size that I have PPM. When I was formally diagnosed with PPM, I and the cardiac surgeon talked about Pibarot - cardiac surgeons refer to him a lot.

Is your St Judes a mechanical or tissue valve ? The surgeon I saw told me that mechanical valves give more valve area per size than tissue valves. Stentless valves give more valve area than stented valves too. Repeated surgeries mean more scar tissue and less room for the replacement valve. And doing root replacement to fit a bigger valve is quite a risky surgery.

I don’t know why I’ve got PPM as I’m absolutely average height and very slim. I think possibly it is that I have a small chest cavity as I have pectus excavatum so my heart is smaller than normal and therefore could only take a small replacement aortic valve which is too small for my body size. I was born with pectus excavatum and bicuspid aortic valve.

 

[Denise1]

Hi @Denise1

I don’t know how common PPM is, there’s only ever been one other person apart from me, and now you, on forum with PPM as far as I know. There's a lot about it on the internet. I emailed one of the cardiologists who has written several papers on it: Dr Philippe Pibarot (do a search with Philippe Pibarot PPM and you will get lots of hits). Dr Pibarot very kindly replied to my email - he was able to tell just from my weight, height and replacement valve make and size that I have PPM. When I was formally diagnosed with PPM, I and the cardiac surgeon talked about Pibarot - cardiac surgeons refer to him a lot.

Is your St Judes a mechanical or tissue valve ? The surgeon I saw told me that mechanical valves give more valve area per size than tissue valves. Stentless valves give more valve area than stented valves too. Repeated surgeries mean more scar tissue and less room for the replacement valve. And doing root replacement to fit a bigger valve is quite a risky surgery.

I don’t know why I’ve got PPM as I’m absolutely average height and very slim. I think possibly it is that I have a small chest cavity as I have pectus excavatum so my heart is smaller than normal and therefore could only take a small replacement aortic valve which is too small for my body size. I was born with pectus excavatum and bicuspid aortic valve.

Hello, I now have a St Jude mechanical valve. I was told by my surgeon that because of all my prior surgeries there was alot of scar tissue which is why he had no choice but go with such a small valve. I will definitely research Dr. Pibarot, thanks for the info!!

 

[bluetux]

https://www.jstage.jst.go.jp/article/circj/76/1/76_CJ-11-0728/_pdf
"Clinical Outcomes and Hemodynamics of the 19-mm Perimount Magna Bioprosthesis in an Aortic Position"

"Background: When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis–patient mismatch (PPM) is of concern because it can affect postoperative clinical outcomes. Although larger bioprosthetic valves have been well studied, the hemodynamics of 19-mm bioprostheses have been reported in only a small number of patients. The effectiveness as well as the impact of PPM on outcomes are thus still unclear.
Methods and Results: Postoperative clinical and hemodynamic variables were compared in 67 patients with a 19- mm Carpentier Edwards Perimount Magna bioprosthesis and in 10 patients with a 19-mm Medtronic Mosaic Ultra valve. Mean follow-up time was 13 months. There was no in-hospital mortality. Echocardiography 6.5±4.0 months after surgery showed significant decreases in the mean left ventricular (LV)–aortic pressure gradient, and decreases in the mean LV mass index. Reduction in LV mass index did not differ between the valve groups, despite a higher pressure gradient in the Mosaic group. Although PPM was detected in 21 patients in the Magna group, it did not affect regression of the LV mass index during the follow-up period.
Conclusions: Use of the 19-mm Magna bioprosthesis appears to provide satisfactory clinical results. LV–aortic pressure gradient was lower in the Magna group. The present data suggest that PPM is not related to reduction in the LV mass index."

 

[nobog]

Hello, I now have a St Jude mechanical valve. I was told by my surgeon that because of all my prior surgeries there was alot of scar tissue which is why he had no choice but go with such a small valve. I will definitely research Dr. Pibarot, thanks for the info!!

If you have a 17mm SJM that would be the Regent series. That valve has better flow characteristics than a standard 19mm SJM - in any event, any size SJM has predictable and reliably low pressure gradients, I do not suspect PPM.