[Doppler echographic evaluation of pressure gradients of Björk-Shiley valve in the aortic position at rest and with exercise].

Pressure gradient across the Björk-Shiley (B-S) valve in the aortic position was assessed by Doppler echocardiography at rest and with exercise. There was close correlation between peak pressure gradient and area index which is a ratio of geometric orifice area (cm2) to body surface area (BSA) (m2). The correlation coefficient was -0.70 at rest and -0.86 with exercise. High peak pressure gradients with exercise were observed in the patients with 19 mm size (71 mmHg) and 21 mm size (107 mmHg). To avoid residual left ventricular outflow obstruction with exercise, it is considered advisable to use a #19 B-S valve in patients with BSA smaller than 1.1 m2, a #21 B-S valve in patients with BSA smaller than 1.4 m2, a #23 B-S valve in patients with BSA smaller than 1.8 m2, and a #25 B-S valve in patients with BSA smaller than 2.3 m2. If proper size of B-S valve cannot be inserted, aortic or aortic-mitral patch annuloplasty or the use of bileaflet valve are recommended as procedures of choice for small aortic annulus.