BLOCK 9: Pulmonary, Tricuspid, & Prosthetic Valves

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Learning Objectives By Lesson
RIGHT-SIDED VALVES
Pulmonary Valve

Describe how to determine right ventricular systolic pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, and pulmonary venous resistance using right-sided hemodynamics
Describe how to use Doppler to assess the right ventricular outflow tract
Identify clinical conditions associated with pulmonary valve stenosis
Explain how M-mode can be useful in the assessment of pulmonary valves stenosis
Describe the relationship between the right-sided pressures (i.e., right ventricular and pulmonary artery pressures) and the pulmonary valve findings on M-mode
Describe how to grade the severity of pulmonary valve stenosis
Identify clinical conditions associated with pulmonary valve regurgitation
List the parameters that can be used to in the evaluation of pulmonary valve regurgitation
Describe the continuous wave Doppler findings associated with pulmonary valve regurgitation

Tricuspid Valve

Identify key tricuspid valve anatomical structures
Explain the reason for the differences in velocities across the tricuspid and mitral valves
Identify clinical conditions associated with tricuspid valve disorders
Describe the etiology of tricuspid valve stenosis
Describe the echocardiographic assessment of tricuspid valve stenosis
Describe the etiology of tricuspid valve regurgitation
Explain the response of the right ventricle in tricuspid valve regurgitation
Describe the echocardiographic assessment of tricuspid valve regurgitation
Describe the hepatic venous profile in tricuspid valve regurgitation

PROSTHETIC VALVES
Prosthetic Valve Classification

Describe the various prosthetic valves available in clinical practice
Explain the role of echocardiography in the evaluation of patients with prosthetic valves
Identify echocardiographic technical challenges when evaluating patients with prosthetic valves
Describe the differences between native and prosthetic valves
Describe the concept of pressure recovery and how it can help explain the differences between invasive and noninvasive-derived gradients
Explain the reason for caution in using the simplified Bernoulli equation when assessing prosthetic valve gradients

Prosthetic Valve Function

Explain the difference between effective orifice area (EOA) and geometric orifice area (GOA)
Describe the aortic prosthesis qualitative and quantitative echocardiographic assessment
Describe the mitral prosthesis qualitative and quantitative echocardiographic assessment

Prosthetic Valve Dysfunction

List the potential causes for increased pressure gradients across prosthetic valves
Describe when to suspect and how to evaluate for aortic prosthetic dysfunction (obstruction and insufficiency)
Describe when to suspect and how to evaluate for mitral prosthetic dysfunction (obstruction and insufficiency)
Describe when to suspect and how to evaluate for pulmonary prosthetic dysfunction (obstruction and insufficiency)
Describe when to suspect and how to evaluate for tricuspid prosthetic dysfunction (obstruction and insufficiency)
Describe the risk of prosthetic valve degeneration and important aspects in evaluation over time

Contributors: Nandan Anavekar, MBBCh; Abdullah Al-abcha, MD; Muhannad Aboud Abbasi, MBBCh; Anthony Kashou, MD
Last updated: July 2023.

Progress

Instructors

GCU Education Team
Physician Educators