A Decade of Experience

Almost 30 years have passed since the first successful use of an artificial heart valve for the treatment of severe valvular heart disease. Replacement of dysfunctional native heart valves with either mechanical or bioprosthetic materials has become the standard therapy for hemodynamically significant lesions with over 110,000 such procedures performed worldwide in 1988. Despite the general success of such valves in the treatment of advanced valvular heart disease, the ideal prosthesis has yet to be developed. All prosthetic valves are mildly stenotic as well as insufficient. Likewise, all are subject to the development of complications including thrombosis, infection, degeneration, dehiscence, fibrous ingrowth, and embolization, and all may manifest hemodynamically significant insufficiency or obstruction secondary to these complications. Throughout the years, a variety of noninvasive techniques including auscultation, fluoroscopy, phonocardiography, and M-mode and two-dimensional echocardiography have been used with limited success in the evaluation of patients with suspected prosthetic valve dysfunction. However, none of these techniques has been sufficiently sensitive or specific to achieve widespread clinical applicability, and cardiac catheterization has remained the reference standard in the evaluation of such patients. The signs and symptoms of prosthetic valvular