Mechanical heart valve prostheses: sound level and related complaints.

In a randomised study, we investigated the sound production of mechanical heart valve prostheses and the complaints related to this sound. The CarboMedics, Bj?rk-Shiley monostrut and StJude Medical prostheses were compared. A-weighted levels of the pulse-like sound produced by the prosthesis were measured in 25 patients after aortic valve replacement. Additionally, 141 patients, 117 after aortic valve replacement, 20 after mitral valve replacement and 4 after double valve replacement were interviewed. The average sound pulse pressure levels were 46.0 +/- 2.9 dB(A) in the Carbomedics group, 55.4 +/- 1.2 dB(A) in the Bj?rk-Shiley monostrut group and 44.1 +/- 4.4 dB(A) in the StJude Medical group, measured at a distance of 1 cm from the chest. The Bj?rk-Shiley monostrut was louder than the other two prostheses (p less than 0.0005). Twenty (14.2%) of all patients had complaints related to the valve sound such as sleeping disturbances, irritation, nervousness or fear. Significantly more patients with a Bj?rk-Shiley monostrut could hear their valve or had complaints when compared to the other two prostheses. Younger patients and patients with a mitral valve prosthesis could hear their valve more often than older patients or patients after aortic valve replacement. We conclude that sound characteristics and related complaints differ considerably among heart valve prostheses.     

Evaluation of valve sound and its effects on ATS prosthetic valves in patients' quality of life

BACKGROUND: We interviewed patients and carried out frequency analyses to compare the closing sounds of ATS and St. Jude Medical (SJM) prosthetic valves. METHODS: Forty-five patients undergoing valve replacements using ATS valves were investigated. We interviewed patients at 1 month and 1 year after the operation, and carried out frequency analysis to investigate the prosthetic valve's closing sound. RESULTS: According to the results of the interviews, 84.4% of patients with ATS valves were not aware of the valve sounds. ATS valves scored significantly lower than SJM valves on audibility of the valve sound, disturbance during daytime, sleep disturbance, request for replacement with a soundless prosthetic valve, audibility to others, and noise index. According to the frequency analysis on the prosthetic valve's closing sound, the sound peak of the ATS valves was around 1.2 kHz, and the sound pressure of the ATS valves was significantly lower than that of the SJM valves. CONCLUSIONS: Though a further long-term observation on thromboembolism and hemolysis is needed for evaluation of prosthetic valves, the ATS valve is presently considered to impart a better quality of life.     

An evaluation study on the quietness of the ATS valve.

BACKGROUND: The closure sound of the ATS bileaflet mechanical valve is said to be quieter than that of the other mechanical valves. However, the reasons for this are still unknown. In this study, we investigated the reasons for the quietness of the ATS valve closure sound. PATIENTS AND METHODS: The valve closure sound was evaluated in 70 patients and in another 70 patients in whom the SJM valve had been used for single valve replacement, based on frequency analysis of the closure sound, measurement of the opening angle of the valve, cardiac function, and patient interviews. RESULTS: In the valve closure sound analysis, the mean peak frequency of the valve closure sound was 1.02 kHz for the ATS valve, and the mean pressure was 22.8+/-4.04 dB. The mean peak frequency of the closure sound of the SJM valve was1.02 kHz, with another intermittent peak at 3 to 9 kHz in the human audibility range. The mean sound pressure was 25.0+/-3.20 dB. The noise classification score was 2.07+/-1.95 points for the SJM valve, significantly higher as compared with that for the ATS valve which was 0.36+/-0.95 points. Multilateral examinations showed a significant difference in the mean opening angle between the ATS and the SJM valves: the angle was 76.6+/-4.67 degrees for the ATS valve and 82.3+/-2.05 degrees for the SJM valve. CONCLUSION: In view of the lower sound pressure in the human audibility range and lower patient awareness of the valve closure sound, the ATS valve would appear to be a superior mechanical valve when compared to the SJM valve from the point of view of the quality of life of the patients. The significant difference in the opening angle in patients with the ATS valve between those who were aware of the valve closure sound and those who were not suggested a possible association between the opening angle and the patient awareness of the valve closure sound.     

Problems associated with mechanical heart valve sounds.

A cross-sectional study of 50 randomly selected patients 12-36 months following mechanical heart valve replacement with Bjork-Shiley tilting disc valves was undertaken to investigate the factors which affect perception of, and reaction to, sounds generated by mechanical heart valves implanted in patients. Numerous problems were generated by the valves, including annoyance (68%), sleep disturbance (52% in patients; and 46% in patients' partners), interference with concentration (36%) and social embarrassment (28%). These findings are not affected by the measured level of sound or any variation in the number or anatomical position of the valve(s), though age and sex do seem to matter, more problems being reported by younger patients and those of the female sex. Aspects of the patient's personality did not seem to alter the difficulties experienced, though a high level of psychological morbidity was identified in the group as a whole. Most patients experience problems due directly to the noise generated by their valve and should be adequately warned of this before operation. This should also be taken into consideration in designing and evaluating new valve prostheses.     

Influence of St. Jude medical valve in patients with aortic stenosis and small aortic annulus on cardiac function and late survival result

This clinical study analyzes our experience of postoperative cardiac function and long-term survival rate in patients with aortic stenosis and small-size St. Jude Medical (SJM) valve. Sixty-eight patients who underwent aortic valve replacement by SJM valve were divided into two groups by preoperative aortic annulus diameter. Group 1 consisted of 44 patients with small aortic annulus and small-size SJM valve (19 mm or 21 mm). In Group 1, small SJM standard valves were implanted in 16 patients, and small SJM Hemodynamic Plus (HP) valves were implanted in 28 patients. Group 2 consisted of 24 patients with large-size SJM standard valve (23 mm or larger). Preoperative left ventricular mass index, left ventricular dimension, the dimension of ascending aorta, and body surface area were significantly smaller in Group 1 than in Group 2. Average age at surgery was older in Group 1 than in Group 2. Effective orifice area index of the SJM valve measured by the manufacturer's data was smaller in Group 1 than in Group 2. Postoperative left ventricular mass indexes of Group 1 (standard valve or HP valve) and Group 2 significantly decreased in comparison with the preoperative mass indexes. Postoperative left ventricular ejection fraction and the peak ejection rate of Group 1 were not different from those of Group 2. The 10 year survival rate of Group 1 was 79%, and the rate of Group 2 was 77%. At 10 years after surgery, freedom from valve-related complication of Group 1 was 80%, and freedom from complication of Group 2 was 81%. Our results demonstrated that small-size SJM valve afforded satisfactory long-term survival rate and valve-related event-free rate for elderly patients with small body surface area and small aortic annulus.     

The St. Jude "Silzone" valve: midterm results in treatment of active endocarditis

BACKGROUND: The Silzone-coated St. Jude Medical valve (SJM "Silzone" valve), developed to reduce prosthetic valve endocarditis (PVE), was recalled by SJM due to a higher rate of paravalvular leaks. The aim of this study was to determine the efficacy of the SJM "Silzone" valve in avoiding PVE and to evaluate the frequency of paravalvular leaks, when the valve was used exclusively for active bacterial endocarditis. METHODS: From January 1998 to December 1999, the SJM "Silzone" valve was implanted in 40 consecutive patients with active endocarditis (20 aortic, 14 mitral, and 6 both valves). Late transesophageal echocardiography was performed in 87% of survivors, and transthoracic echocardiography in the remaining 13%. Follow-up was 100%. RESULTS: Hospital mortality was 17.5%. Early PVE occurred in 2 of 40 patients (5%). There were two late deaths without signs of recurrent PVE. A hemodynamic relevant paravalvular leak necessitating reoperation was seen in 2 patients within 6 months after operation. The rate of a minor paravalvular leak was 13% (4 of 31 patients). CONCLUSIONS: The SJM "Silzone" valve when implanted for active bacterial endocarditis does not give better results than other mechanical prostheses with regard to early recurrence of endocarditis. The rate of a hemodynamic relevant paravalvular leak requiring reoperation seems rather high during the early postoperative period, whereas the occurrence of minor paravalvular leaks is comparable with that of other mechanical prostheses. Routine observation, recommended for all patients with mechanical heart valves, is also sufficient for patients with the SJM "Silzone" valve.     

Tricuspid valve replacement with the St. Jude Medical valve

A study was conducted on 20 patients who underwent tricuspid valve replacement (TVR) with the St. Jude Medical (SJM) valve. Isolated TVR was performed on 9 patients, and additional mitral, or mitral and aortic valve replacements were performed on 11 patients. Four patients (20%) died in the early postoperative period, but there were no deaths related to the SJM valve in the tricuspid position. The mean follow-up period of the 16 survivors was 74.4 months, and there have been no deaths during the follow-up period. The postoperative actuarial survival rate was 80%, 10 years after surgery. Three patients, representing 0.25%/patient-months, developed valve thrombosis, the valve thrombosis-free rate being 72.8%, 10 years after surgery, while entrapment of a leaflet by endothelial pannus was found in one patient, representing 0.08%/patient-months. Thus, the incidence of all prosthetic valve-related complications was 0.34%/patient-months, and the postoperative complication-free rate was 65.3%, 10 years after surgery. The medium-term follow-up study of TVR with the SJM valve revealed no prosthetic valve-related deaths and a relatively low incidence of prosthetic valve-related complications. However, as with other mechanical valves, valve thrombosis was a major risk posed by the SJM valve in the tricuspid position.     

Operative results of tricuspid valve replacement with St. Jude Medical prosthesis

Since 1974, 14 patients underwent tricuspid valve replacement (TVR) with prosthetic heart valves. Hardy's operation was undergone in 2 patients with Ebstein's anomaly and mitral valve surgery or multiple valve surgery were undergone in 9 patients with rheumatic valvular disease, concomitantly. Four types of prosthetic heart valves were used in the tricuspid position, i.e. 2 Starr-Edwards prostheses, 1 Hancock xenograft, 1 Bj?rk-Shiley prosthesis and 12 st. Jude Medical prostheses. The operative mortality rate was 14.3% (2/14) and 2 hospital deaths were due to low cardiac output syndrome. Twelve survivors have been followed with a maximum follow-up of 13 years and the mean of 4.7 years. There were 3 late deaths due to congestive heart failure and prosthetic valve endocarditis (PVE) of the aortic Bj?rk-Shiley prosthesis. There was 1 PVE of the tricuspid Starr-Edwards prosthesis and 1 thrombosis of the tricuspid Bj?rk-Shiley prosthesis, but no thrombosis and no other valve-related complications of SJM prostheses in the tricuspid position. The post-operative NYHA function class improved satisfactorily in 9 survivors. Judging from our relatively satisfactory post-operative results in TVR cases using SJM prostheses, SJM prosthesis in the tricuspid position is one of advisable prosthesis to get satisfactory hemodynamic improvement post-operatively.     

Thrombosis of two St. Jude Medical prostheses in one patient after triple valve replacement. Case report and review of the literature

Reports of experience with the St. Jude Medical (SJM) valve state that thrombosis of the prosthesis is a rare complication. In a 57-year-old woman, reoperation was necessary 12 months after triple valve replacement using SJM prostheses because of thrombosis of the valves in the tricuspid and aortic positions. Dysfunction of both mechanical valves was detected clinically by changing heart sounds and the appearance of murmurs. Echocardiography and cinefluoroscopy confirmed at least one fixed leaflet of the tricuspid prosthesis, but abnormalities of the aortic prosthesis could not be detected. At reoperation, the SJM prosthesis in the tricuspid position was almost completely thrombosed and was replaced by an Ionescu-Shiley bioprosthesis. A thrombotic formation at the hinge point of the SJM aortic prosthesis was removed. To our knowledge, this is the first report of a thrombotic complication of two SJM prostheses after triple valve replacement in one patient.     

In vitro hydrodynamic characteristics of heart valves in tricuspid position

At present there are many problems concerning the choice of heart valve for cardiac valve replacement in the tricuspid position. Thus, we devised an attachment head for the prosthetic valve in order to evaluate the hemodynamic characteristics of four clinically-available mechanical prosthetic valves and two xenografts in the pulsatile circulation system in the tricuspid position. Six artificial cardiac valves were used in this experiment; St. Jude Medical (SJM), Starr Edwards ball (S-E), monostrut Bj?rk Shiley (B-S), Omnicarbon, Carpentier Edwards (CE) supraannular, CE-pericardial whose tissue annulus diameter was 27 mm. The experimental instrument similar to that of Umezu et al, was prepared to determine the mean pressure gradient, output and calculated orifice area of each valve. Since many of the patients who must undergo tricuspid valve replacement have severe multi valvular diseases with atrial fibrillation, we experimented also under the condition of atrial fibrillation. At sinus rhythm under pulsation flow, no significant difference was shown in cardiac output between the various valves, but pressure gradient was higher with xenografts than with mechanical prostheses, and the SJM valve showed the widest efficient valve orifice area. The reduction rate of the efficient valve orifice area from sinus rhythm to atrial fibrillation was about 10% in the SJM valve, which was better rate than other heart valves. We observed significant differences in cardiac output, pressure gradient and efficient orifice area at sinus and atrial fibrillation rhythm. (p less than 0.01).     

Clinical comparison of 27 size sorin and medtronic mitral prostheses

Background  This study was aimed to evaluate the merit in clinical and hemodynamic performance of two commonly used tilting disc heart valve prostheses at our center. Methods  Between October 1994 and December 1997, 100 patients who received either Sorin Biomedica (n=50; group I) or Medtronic Hall (N=50; group II) 27 size mitral valve prostheses were included in the study. The two groups were similar with respect to age, sex, body surface area, preoperative rhythm, NYHA class, hemodynamic and operative parameters. Results  The overall early mortality in the entire series was 5.0%. It was not significantly different in the two groups. A cumulative follow-up of 99.83 patient year for group I and 123.83 patient year for group II, revealed late mortality of 6.23% and 6.38% respectively. The valve related events, acturial survival and echocardiographic assessment of trans-valvular gradient demonstrated no significant difference between the two groups. Conclusions  The results of this study 4 years following implantation indicate that the clinical and hemodynamic performance of 27 size Sorin Biomedica and Medtronic Hall were similar. Both the tilting prostheses were in conformity with small mitral annulus particularly in stenotic lesion and in those who had smaller body surface area. The choice of either prostheses entirely depended upon the surgeon’s preference which was linked to other factors such as experience, ease of insertion, availability and cost. Paper presented in the Annual Conference of Indian Association of Cardiovascular and Thoracic Surgeons at Mumbai, India on 8th March 2000.     

Mid-term results of ATS open pivot bileaflet mechanical prosthetic heart valve.

We investigated mid-term results of the patients with an ATS bileaflet valve in our institution. In the past 6 years, 69 patients received valve replacement with an ATS valve. We assessed the changes of serum lactate dehydrogenase (LDH) level in the hospital, and the valve's closing sound. The serum LDH level had almost normalized one week postoperatively and they have maintained normal levels since then. According to the questionnaire about the valvular sound at a random period after surgery, it was unnoticeable in 61 (88.4%) of the patients with ATS valve. In the 8 patients (12.6%) who recognized the valve sound, 7 of them were reoperation cases. As to the frequency analysis for the valve's closing sound, the sound peak was indicated at around 1.2 kHz in the patients with ATS valves. In patients with St. Jude Medical (SJM) valves, it appeared not only around 1.2 kHz but also around 2 to 7 kHz. Postoperative cerebral infarction was complicated in one patient. Mortality occurred in 4 (5.7%) of the patients with ATS valves. The follow up periods were from one to 66 months. Thromboembolic event free and actuarial survival rate in the patients with ATS valves were 98.6% and 94.2%, respectively. These results indicated that the ATS valve is considered to be a safe valve and mid-term follow-up shows excellent results in terms of the patients quality of life.     

Left Ventricular Mass Regression After Implantation of St. Jude Medical Cardiac Valves in Small Aortic Roots

In this study, we analyzed the extent of regression of left ventricular hypertrophy in patients who received small St. Jude Medical (SJM) aortic valves and compared the results with those of another group receiving larger valves. Eighty-eight patients received either 19 or 21 mm valves (Group 1, 25 patients) or either 23 or 25 mm valves (Group 2, 53 patients). Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up a significant reduction in the left ventricular mass was found for both patient groups (p < 0.0001). Doppler echocardiography derived pressure gradients for both groups were obtained during the follow-up period. As expected, the patients in Group 1 had higher peak pressure gradients than did those in Group 2. However, there was no significant difference between the 2 groups or any significant correlations between peak pressure gradients and body surface area (BSA). Actuarial survival was 84.7% at 15 years for Group 1 and 85.9% at 17 years for Group 2. Actuarial freedom from valve related events was 91.4 % at 15 years for Group 1 and 82.7% at 17 years for Group 2. There was no significant difference in survival or valve related event free curves between the 2 groups. After implantations of SJM valves in small aortic roots, significant left ventricular mass regression was obtained, and the results were comparable to those for valves of other sizes. The long-term performance of aortic valve replacement with small valves was satisfactory as judged by improvement in the functional class of patients and survival statistics, the durability of the prosthesis, and valve related morbidity comparable to that of valves of other sizes.     

复杂性感染性心内膜炎的外科治疗

目的评价瓣周脓肿、心肌脓肿以及瓣膜严重毁损等复杂性感染性心内膜炎手术治疗的近、远期疗效.方法回顾性分析1988年12月至2002年6月手术治疗的复杂性心内膜炎患者57例临床资料,均为原发性心内膜炎,其中感染侵犯主动脉瓣25例、二尖瓣16例、二尖瓣和主动脉瓣16例.术中发现瓣叶严重毁损32例、主动脉瓣周脓肿19例、主动脉根部环形脓肿导致左心室-主动脉连接破坏4例、二尖瓣后瓣环脓肿11例、心肌脓肿6例、瓣膜赘生物形成55例.脓肿清除后遗留残腔采用间断褥式缝合6例、自体心包片修补19例、牛心包片修补6例、聚四氟乙烯膨体补片修补4例;施行以带瓣管道作升主动脉根部替换和左、右冠状动脉移植术4例,主动脉瓣替换术21例,二尖瓣替换术16例,主动脉瓣及二尖瓣双瓣替换术16例.结果早期死亡6例(11%),死亡主要原因为低心输出量综合征、人造心脏瓣膜性心内膜炎和多脏器功能衰竭.随访4个月至14年,平均(5.93±0.20)年.晚期死亡5例,晚期主要并发症为人造瓣膜性心内膜炎.术后1年心功能恢复NYHA分组Ⅰ～Ⅱ级占96%(44/46);5年再手术免除率为(84±3)%,5年实际生存率为(61±9)%.结论复杂性心内膜炎局部组织破坏较多,应限期手术或急症手术,清创后残腔的处理是影响手术本身能否成功以及术后近、远期效果的关键.     

Nonsurgical correction for thrombosis of a St. Jude Medical tricuspid prosthesis: Report of a case

A 43-year-old woman with rheumatic heart disease underwent replacement of the aortic, mitral, and tricuspid valves using three SJM prostheses. Despite adequate warfarin therapy, routine cineradiography performed on the 40th postoperative day showed one of the leaflets of the tricuspid prosthesis to be “stuck” in the semiclosing position. A thrombosis of the tricuspid prosthesis was successfully treated with a urokinase infusion and mechanical thrombolysis using a pacemaker, following which normal valve function was restored.     

Pediatric valve replacement, 15 years experience in Oman

Background Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Somatic growth and adequate anticoagulation are of concern when children undergo valve replacement. We conducted this study to evaluate the performance of valves in this age group. Methods 42 children under the age of 13 years who underwent valve replacement were included in this study. Totally, 50 valves were implanted in 42 patients: 48 were mechanical prostheses, two were bioprosthetic both in pulmonary position. 37 (74%) valves were implanted in mitral position, 10 (20%) in aortic position, 1 (2%) in tricuspid position and 2 (4%) in pulmonary position. Preoperatively, 14 (33,3%) patients were in New York Heart Association (NYHA) class IV, while 27 (64.2%) were in NYHA class III. Results There were 2 (4.7%) hospital deaths and 2 (4.7%) late deaths while 2 (4.7%) patients were lost to follow up. The mean follow up period was 9.4 yrs. 35 (83.3%) patients are in NYHA Class I and free of all medications except warfarin. 3 (7.1%) patients have undergone 5 successful pregnancies. The median INR was 2.23. Major thrombo-embolic episode occurred in 1 (2.3%) patient. Conclusions In view of the problems of sizing, anticoagulation and need for re-operation at an early age, there is a reluctance to replace valves in children. This study shows that despite these problems, valve replacement can be undertaken safely and successfully in children, when repair has failed or not technically feasible.     

Surgical management of valve replacement in children

From 1965 to 1990, 49 valve replacements were performed on 43 patients under the age of 15. Mitral valve replacements were performed on 21 patients, and re-replacements were done on 4 of them afterwards. In the first 9 mitral valve replacements before 1974, Starr-Edwards (S-E) ball valves were used. Five of these patients died in the hospital (early mortality rate was 56%). Since 1975, bioprosthetic valves were used in three cases, but all of these valves ceased to function due to primary tissue failure (PTF) within 3 years. Consequently, SJM valves are now used as a first choice. Ten aortic valve replacements were performed on 9 patients with the results of one early death, two late deaths, and one late re-operation. Tricuspid valve replacements were performed on 11 patients, 5 of whom utilized S-E ball valves. Three of the five patients died in the hospital. One patient was re-operated on, swapping the S-E ball valve for the SJM valve. SJM valves were used primarily in 2 patients, and bioprosthetic valves in 4. Two patients died, one with a SJM valve, and the other with a bioprosthetic valve. Two pulmonary valve replacements were performed, one employing a SJM valve, the other a bioprosthetic valve. Two adult patients with SJM valve in the right side of the heart had thrombotic complications, though the patients with bioprosthetic valves had none. Atrioventricular valve replacements were performed on 5 patients under the age of 3, but all of them died.(ABSTRACT TRUNCATED AT 250 WORDS)     

2349例心脏瓣膜置换术早期死亡原因分析

目的 分析2349例心脏瓣膜置换术病人的死亡原因,以期进一步提高治疗水平.方法 1995年1月至2007年12月,2349例心脏瓣膜病病人接受人工心脏瓣膜置换手术.其中二尖瓣置换术(MVR)1333例,主动脉瓣置换术(AVR)271例,二尖瓣、主动脉瓣同期置换术(DVR)736例,三尖瓣置换术(TVR)9例.结果 早期病死率1995年至1999年6.81%,2000年至2004年3.22%,2005年至2007年2.82%.全组总早期病死率3.40%.结论 心脏瓣膜置换术早期死亡的原因主要是低心排血量综合征、肾功能衰竭、心律失常、肺部感染、脑血管意外、左室破裂和多器官系统功能衰竭等.     

Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses

OBJECTIVESSutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population.METHODSFrom 2011 to 2019, a total of 3402 patients in 11 hospitals underwent isolated aortic valve replacement with minimal access approaches using a bioprosthesis. A total of 475 patients received sutureless valves; 2927 received standard valves. The primary outcome was the incidence of 30-day deaths. Secondary outcomes were the occurrence of major complications following procedures performed with sutureless or standard bioprostheses. Propensity matched comparisons was performed based on a multivariable logistic regression model.RESULTSThe annual number of sutureless valve implants increased over the years. The matching procedure paired 430 sutureless with 860 standard aortic valve replacements. A total of 0.7% and 2.1% patients with sutureless and standard prostheses, respectively, died within 30 days (P = 0.076). Cross-clamp times [48 (40–62) vs 63 min (48–74); P = 0.001] and need for blood transfusions (27.4% vs 33.5%; P = 0.022) were lower in patients with sutureless valves. No difference in permanent pacemaker insertions was observed in the overall population (3.3% vs 4.4% in the standard and sutureless groups; P = 0.221) and in the matched groups (3.6% vs 4.7% in the standard and sutureless groups; P = 0.364).CONCLUSIONSThe use of sutureless prostheses is advantageous and facilitates the adoption of a minimally invasive approach, reducing cardiac arrest time and the number of blood transfusions. No increased risk of permanent pacemaker insertion was observed.Open in a separate window     

Hernodynamic Performance of the St. Jude Medical Hemodynamic Plus Valve

Abstract: The hemodynamic performance of the St. Jude Medical Hemodynamic Plus valve (HP) for a small aortic annulus was compared to that of the standard St. Jude Medical valve (SJM). Doppler echocardiographic parameters were evaluated in patients undergoing aortic valve replacement with either a 19 mm HP (HP19, n = 71, a 21 mm HP (HP21, n = S), a 19 mm SJM (SJM19, n = 16), or a 21 mm SJM (SJM21, n = 34). The peak and mean pres sure gradients and peak flow velocity were significantly (p < 0.05) lower in both patients with the HP21 and those with the HP19 than patients with the SJM21 and those with the SJM19, respectively. The echocardiographic parameters of the patients with the HP19 corresponded closely to those of patients with the SJM21. The left ventricular mass index regressed markedly in patients with the HP19 during the late postoperative period. The results suggested that the hemodynamic performances of certain sizes of the HP were superior to those of the same sue SJMs and were considered to be equivalent to those of the next size larger SJM.