Letter by House et al Regarding Article, “Prosthesis-Patient Mismatch in Bovine Pericardial Aortic Valves: Evaluation Using 3 Different Modalities and Associated Medium-Term Outcomes”
To the Editor:
The proverbial gold standard for evaluating prosthesis-patient mismatch (PPM) is the effective orifice area index. This is attributable to the inverse relationship that exists between the effective orifice area index and mean gradient.1 Other tools have been promoted to identify PPM but have not withstood scrutiny.1
In a recent edition of Circulation: Cardiovascular Imaging, Chacko et al2 propose applying the American Society of Echocardiography guidelines for prosthetic valves to exclude the presence of PPM. In these guidelines, there is a useful algorithm for the evaluation of high transprosthetic gradients.3 This algorithm was specifically created to assist in the evaluation of aortic prostheses with elevated peak velocities exceeding 3 m/sec.
A common pathogenesis of velocities exceeding 3 m/sec …