Patient-prosthetic aortic valve mismatch: role of the echocardiographer.

Patient-prosthetic aortic valve mismatch (PPM) is a clinical diagnosis in which an aortic prosthetic valve is normal structurally, but hemodynamically functions as aortic stenosis, with higher prosthetic valve gradients than would be expected for that particular valve.1,2 The prosthetic valve functions as designed but hemodynamics are less than ideal compared with a native valve. The predominant hemodynamic consequence of PPM is generation of an abnormally high mean pressure gradient (MPG), which may become evident only during or after exercise. The MPG is related to flow (Q) and prosthetic effective orifice area (EOA) by the following relationship: