Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

William A. Zoghbi, MD (Chair), Pei-Ni Jone, MD (Co-Chair), Mohammed A. Chamsi-Pasha, MD, Tiffany Chen, MD, Keith A. Collins, MS, RDCS, Milind Y. Desai, MD, MBA, Paul Grayburn, MD, Daniel Groves, MD, Rebecca T. Hahn, MD, Stephen H. Little, MD, Eric Kruse, RDCS, Danita Sanborn, MD, Sangeeta B. Shah, MD, Lissa Sugeng, MD, Madhav Swaminathan, MD, MBBS, Jeremy Thaden, MD, Paaladinesh Thavendiranathan, MD, SM, Wendy Tsang, MD, SM, Jonathan R. Weir-McCall, MD, MBChB, PhD, and Edward Gill, MD

In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation.

Accreditation Statement: 

The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®.   Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.

ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.

• Release Date: January 3, 2024
• Expiration Date January 3, 2025 - CME/MOC must be claimed by this date.

Learning Objectives:

1. Recognize the wide variety of types and sizes of prosthetic heart valves (PHV)
2. Apply 3-dimensional echocardiographic techniques in the assessment of prosthetic heart valves
3. Consider the differences between percutaneously and surgically implanted prosthesis
4. Identify appropriate utilization of Computed Tomography (CT) and Magnetic Resonance Imaging (CMR) for the evaluation of PHVs

Accreditation Statement: 

The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®.   Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.

ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.

• Release Date: January 3, 2024
• Expiration Date January 3, 2025 - CME/MOC must be claimed by this date.

Disclosures:

ASE is committed to ensuring that its educational mission, and all accredited continuing educational programs provide a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

While a monetary or professional affiliation with an ineligible company does not necessarily influence a speaker’s presentation, the Standards for Integrity and Independence in Accredited Continuing Education and policies of the ACCME require that all financial relationships with ineligible companies* be identified and mitigated prior to engaging in an accredited CE activity. In accordance with these policies, ASE actively identified relevant financial relationships between faculty in control of this accredited CE activity and ineligible companies and implemented mitigation strategies to eliminate any potential influence from persons or organizations that may have an incentive to insert commercial bias in this activity. (*Companies that are ineligible to be accredited in the ACCME System (“ineligible companies”) are those whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.)

At the time this article was published, the authors reported no actual or potential conflict of interest relative to the content.

Members of the ASE CME Committee members (not serving as faculty) do not have any financial relationships with ineligible companies.  Click here for a list of these members.

None of the ASE staff who were involved in the planning and implementation of this educational activity have relevant financial relationship(s) to disclose with ineligible companies.  Click here for a list of ASE staff members.

No commercial support was provided for this activity.

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