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Prosthesis-Patient Mismatch — EECC MCQ

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HardValvular Heart DiseaseProsthesis-Patient MismatchEECC

A 72-year-old woman undergoes surgical aortic valve replacement with a 19 mm bioprosthetic valve. Her body surface area is 1.8 m². Postoperative echocardiography shows a mean transvalvular gradient of 28 mmHg with an effective orifice area index (EOAi) of 0.62 cm²/m². What does this finding represent?

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Correct answer: D — Prosthesis-patient mismatch (PPM)

Prosthesis-patient mismatch (PPM) occurs when the effective orifice area of the prosthetic valve is too small relative to the patient's body size. It is defined by the indexed EOA (EOAi): moderate PPM is EOAi 0.65-0.85 cm²/m² and severe PPM is EOAi <0.65 cm²/m². This patient's EOAi of 0.62 cm²/m² indicates severe PPM, resulting in persistently elevated transvalvular gradients. PPM should ideally be anticipated preoperatively and prevented by selecting an appropriately sized valve, using a stentless or sutureless valve, or performing aortic root enlargement. Severe PPM is associated with worse long-term outcomes including increased mortality.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease