Prosthetic Valves

Stenosis criteria by position, and normal Doppler values by valve model and size

ASE 2024 prosthetic valves (with SCMR and SCCT)

Position

Pulmonary

When to suspect stenosis, Adult-Derived · ASE 2024, Table 15
Measure	Normal	Possible obstruction
Peak velocity (m/s)	Bioprosthesis <3.2 Homograft <2.5	Bioprosthesis ≥3.2 Homograft ≥2.5
Mean gradient (mmHg)	Bioprosthesis <20 Homograft <15	Bioprosthesis ≥20 Homograft ≥15
Valve and flow	Normal structure and motion; laminar flow	Abnormal structure and motion; turbulent, narrow color jet
Against baseline	Stable gradients, velocity, RV pressure, RV size and function, DVI	Higher gradients, velocity and RV systolic pressure; larger RV, lower function; lower DVI

Table A7 · Pulmonary prostheses · 26 rows Mixed sources

Table A7. Normal Doppler echocardiographic values for prosthetic pulmonary valves. Mean ± SD or median (IQR). AT, acceleration time of the prosthetic valve. ASE 2024, Appendix.

Valve	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	Peak velocity (m/s)	AT (ms)	EOA (cm²)
HomograftEgbe 2019 · adults with CHD		<25	<15	<2.5
Valved conduits Egbe 2019 · adults with CHD
Contegra	12-22
Shelhigh	10-24		<15	<2.2
Medtronic	19-29
Bioprosthetic valvesEgbe 2019 · adults with CHD			<15	<2.2
Percutaneous pulmonary valves (Melody)Jalal 2021	16 (≤20)			<2.4
Percutaneous pulmonary valves (Melody)	18 (≤22)			<2.4
Percutaneous pulmonary valves (SAPIEN)Hahn 2019 · aortic data	20		16 ± 5			1.22 ± 0.2
Percutaneous pulmonary valves (SAPIEN)	23		11 (8-17)			1.47 (1.1-2)
Percutaneous pulmonary valves (SAPIEN)	26		9.5 (4.9-14.5)			1.77 (1.3-2.4)
Percutaneous pulmonary valves (SAPIEN)	29		10.4 (5.9-15.5)			2 (1.5-2.6)
Percutaneous pulmonary valve native outflow (Alterra Stent with SAPIEN)		No data
Percutaneous pulmonary valve native outflow (Harmony)		No data
Mechanical valves (St. Jude)Shojaeifard 2020	21	20 (19-21)	12 (11-13)	2.2	98 (85-110)	1.73
Mechanical valves (St. Jude)	23	20 (7-35)	11 (4-20)	2 (1.2-2.9)	87 (52-118)	2.5 (1-3.8)
Mechanical valves (St. Jude)	25	18 ± 7.5	11 ± 6	2	83 ± 11	2.9 ± 1
Mechanical valves (St. Jude)	27	15 (6-30)	6 (3-18)	1.8 (1.2-2.7)	90 (72-116)	4.2 (3-4.8)
Mechanical valves (St. Jude)	31	14	7	1.6	93	5.73
Mechanical valves (Carbomedics)Shojaeifard 2020	23	19 (17-20)	12	2 (1.8-2.2)	78 (70-85)	1.7 (1.3-2.1)
Mechanical valves (Carbomedics)	25	20 (11-30)	11 (5-33)	2 (1.6-2.7)	89 (64-108)	3.3 (1.5-4.4)
Mechanical valves (Carbomedics)	27	19 (10-28)	10 (6-14)	1.9 (1.4-2.4)	78 (75-80)	4.1 (4-4.1)
Mechanical valves (Carbomedics)	29	14	7	1.7	76	2.6
Mechanical valve On-XShojaeifard 2020	23	20 (7-36)	12 (4-22)	2.2 (1.1-2.7)	112 (106-118)	2.4 (1.9-2.9)
Mechanical valve On-X	25	17 (7-24)	10 (3-13)	1.8 (1.3-2.4)	100 (55-118)	1.5 (0.9-2.2)
Mechanical valve On-X	27	23	13	2.2	113	1.9
Mechanical valve On-X	29	20 (18-22)	12 ± 1	2.1 (1.9-2.3)	103 (95-110)	2.02 (1.8-2.2)

Row sources: Egbe 2019, Jalal 2021, Hahn 2019, Shojaeifard 2020

Aortic

When to suspect stenosis, Adult-Derived · ASE 2024, Table 5
Measure	Normal	Possible stenosis	Suggests significant stenosis
All prosthetic aortic valves
Jet velocity contour	Triangular, early peaking	Triangular to intermediate	Rounded, symmetric
Acceleration time (ms)	<80	80–100	>100
AT / LV ejection time	<0.32	0.32–0.37	>0.37
Peak velocity (m/s)	<3	3–4	≥4
SAVR
Mean gradient (mmHg)	<20	20–34	≥35
DVI	>0.35	0.25–0.35	<0.25
EOA	Reference EOA ± 1 SD	1 SD smaller than reference EOA	2 SDs smaller than reference EOA
TAVI: change from baseline
Mean gradient	Change <10 mmHg	Increase of 10–19 mmHg	Increase ≥20 mmHg
DVI	Change <0.1 or 20%	Decrease 0.1–0.19 or 20%–39%	Decrease ≥0.2 or ≥40%
EOA	Change <0.3 cm² or 25%	Decrease of 0.3–0.59 cm² or 25%–49%	Decrease ≥0.6 cm² or ≥50%

Some normal values cross these cut-offs

Prosthesis–Patient Mismatch (PPM), Adult-Derived · ASE 2024, Table 7
Indexed EOA (cm²/m²)	Normal	Moderate	Severe
BMI <30 kg/m²	>0.85	0.85–0.66	≤0.65
BMI ≥30 kg/m²	>0.70	0.70–0.56	≤0.55

Structural valve deterioration (Table 6)

Hemodynamic criteria for structural valve deterioration, compared with the baseline study 1–3 months after the procedure (ASE 2024, Table 6). Criteria assume stable LV function and blood pressure, and adverse changes in the prosthesis's morphology should be evident.
Finding	Possible	Significant
Mean gradient	Increase ≥10 mmHg to a mean gradient ≥20 mmHg, with a decrease in EOA ≥0.3 cm² or ≥25% and/or in DVI ≥0.1 or ≥20%	Increase ≥20 mmHg to a mean gradient ≥30 mmHg, with a decrease in EOA ≥0.6 cm² or ≥50% and/or in DVI ≥0.2 or ≥40%
Intraprosthetic AR	New, or worse by at least one grade, reaching moderate or greater	New, or worse by at least two grades, reaching moderate or greater to severe

With combined stenosis and regurgitation, significant deterioration may be present at lower thresholds. The guideline notes that its criteria differ slightly from other published criteria.

Table A1 · SAPIEN valves (TAVI) · 15 rows Adult

Table A1. Normal Doppler echocardiographic values for percutaneous SAPIEN valves in native aortic stenosis by valve size. Mean ± SD. NA, not applicable. ASE 2024, Appendix.

Valve iteration	Size	EOA (cm²)	Mean gradient (mmHg)	DVI
SAPIEN	20 mm	NA	NA	NA
SAPIEN	23 mm	1.56 ± 0.43	9.92 ± 4.27	0.53 ± 0.13
SAPIEN	26 mm	1.84 ± 0.52	8.76 ± 3.89	0.53 ± 0.13
SAPIEN	29 mm	NA	NA	NA
SAPIEN	All sizes	1.70 ± 0.49	9.36 ± 4.13	0.53 ± 0.13
SAPIEN XT	20 mm	NA	NA	NA
SAPIEN XT	23 mm	1.41 ± 0.30	10.41 ± 3.74	0.52 ± 0.10
SAPIEN XT	26 mm	1.74 ± 0.42	9.24 ± 3.57	0.54 ± 0.11
SAPIEN XT	29 mm	2.06 ± 0.52	8.36 ± 3.14	0.53 ± 0.11
SAPIEN XT	All sizes	1.67 ± 0.46	9.52 ± 3.64	0.53 ± 0.11
SAPIEN 3	20 mm	1.22 ± 0.22	16.23 ± 5.01	0.42 ± 0.07
SAPIEN 3	23 mm	1.45 ± 0.26	12.79 ± 4.65	0.43 ± 0.08
SAPIEN 3	26 mm	1.74 ± 0.35	10.59 ± 3.88	0.43 ± 0.09
SAPIEN 3	29 mm	1.89 ± 0.37	9.28 ± 3.16	0.40 ± 0.09
SAPIEN 3	All sizes	1.66 ± 0.38	11.18 ± 4.35	0.43 ± 0.09

Modified from Hahn 2019 (guideline ref 11), with permission

Table A2 · CoreValve and Evolut R (TAVI) · 10 rows Adult

Table A2. Normal Doppler echocardiographic values for percutaneous CoreValve and Evolut R valves by valve size in native aortic stenosis. Mean ± SD. ASE 2024, Appendix.

Valve iteration	Size	EOA (cm²)	Mean gradient (mmHg)	DVI
CoreValve	23 mm	1.12 ± 0.36	14.43 ± 5.72	0.44 ± 0.09
CoreValve	26 mm	1.74 ± 0.49	8.27 ± 3.82	0.59 ± 0.15
CoreValve	29 mm	1.97 ± 0.53	8.85 ± 4.17	0.54 ± 0.12
CoreValve	31 mm	2.15 ± 0.72	9.55 ± 3.44	0.49 ± 0.12
CoreValve	All sizes	1.88 ± 0.56	8.85 ± 4.14	0.55 ± 0.13
Evolut R (30 d)	23 mm	1.09 ± 0.26	14.97 ± 7.15	0.42 ± 0.04
Evolut R (30 d)	26 mm	1.69 ± 0.40	7.53 ± 2.65	0.61 ± 0.13
Evolut R (30 d)	29 mm	1.97 ± 0.54	7.85 ± 3.08	0.59 ± 0.14
Evolut R (30 d)	34 mm	2.60 ± 0.75	6.30 ± 3.23	0.58 ± 0.15
Evolut R (30 d)	All sizes	2.01 ± 0.65	7.52 ± 3.19	0.59 ± 0.14

Modified from Hahn 2019 (guideline ref 11), with permission

Table A3 · Aortic valve-in-valve at 1 year · 4 rows Adult

Table A3. Doppler echocardiographic parameters for percutaneous aortic ViV at 1 year after the procedure. Mean ± SD. THV, transcatheter heart valve. ASE 2024, Appendix.

TAVI ViV	THV size	Peak gradient (mmHg)	Mean gradient (mmHg)	EOA (cm²)
CoreValve	All	23.48 ± 12.10	12.89 ± 0.20	1.62 ± 0.14
Evolut	All	22.43 ± 5.72	14.70 ± 9.11	1.36 ± 0.07
SAPIEN 3	All	33.93 ± 10.11	27.00 ± 10.20	1.07 ± 0.32
SAPIEN XT	All	31.31 ± 3.75	18.02 ± 4.22	1.31 ± 0.25

Derived from the respective publications

Table A4 · Surgical aortic valves · 211 rows Adult

Table A4. Normal Doppler echocardiographic values for surgical prosthetic aortic valves. Mean ± SD. ASE 2024, Appendix.

Valve	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	EOA (cm²)
Abbott Epic	21		19.1 ± 8.2	1.0 ± 0.3
Abbott Epic	23		13.9 ± 6.0	1.4 ± 0.5
Abbott Epic	25		12.1 ± 5.1	1.5 ± 0.5
Abbott Epic	27		11.4 ± 4.1	1.6 ± 0.4
Abbott Epic	29		7.5 ± 3.3	2.4 ± 1.1
Abbott Trifecta	19		10.7 ± 4.6	1.41 ± 0.24
Abbott Trifecta	21		8.1 ± 3.5	1.63 ± 0.29
Abbott Trifecta	23		7.2 ± 2.8	1.81 ± 0.30
Abbott Trifecta	25		6.2 ± 2.7	2.02 ± 0.32
Abbott Trifecta	27		4.8 ± 2.0	2.20 ± 0.20
Abbott Trifecta	29		4.7 ± 1.6	2.35 ± 0.22
Arbor Surgical Trilogy	21	21 ± 8	11 ± 6	1.9 ± 0.2
Arbor Surgical Trilogy	23	15 ± 7	8 ± 4	2.0 ± 0.3
ATS Bileaflet	19	47.0 ± 12.6	25.3 ± 8.0	1.1 ± 0.3
ATS Bileaflet	21	23.7 ± 6.8	15.9 ± 5.0	1.4 ± 0.5
ATS Bileaflet	23		14.4 ± 4.9	1.7 ± 0.5
ATS Bileaflet	25		11.3 ± 3.7	2.1 ± 0.7
ATS Bileaflet	27		8.4 ± 3.7	2.5 ± 0.1
ATS Bileaflet	29		8.0 ± 3.0	3.1 ± 0.8
ATS AP Bileaflet	18		21.0 ± 1.8	1.2 ± 0.3
ATS AP Bileaflet	20	21.4 ± 4.2	11.1 ± 3.5	1.3 ± 0.3
ATS AP Bileaflet	22	18.7 ± 8.3	10.5 ± 4.5	1.7 ± 0.4
ATS AP Bileaflet	24	15.1 ± 5.6	7.5 ± 3.1	2.0 ± 0.6
ATS AP Bileaflet	26		6.0 ± 2.0	2.1 ± 0.4
ATS 3F Enable	21	27.0 ± 8.4	15.0 ± 4.6	1.1 ± 0.4
ATS 3F Enable	22	25.7 ± 10.8	14.5 ± 6.0	1.4 ± 0.4
ATS 3F Enable	25	20.3 ± 7.4	11.4 ± 4.0	1.6 ± 0.5
ATS 3F Enable	27	16.8 ± 6.3	9.4 ± 3.3	1.9 ± 0.5
ATS 3F Enable	29	14.3 ± 6.7	7.8 ± 3.8	2.4 ± 0.8
Baxter Perimount Stented bovine pericardial	19	32.5 ± 8.5	19.5 ± 5.5	1.3 ± 0.2
Baxter Perimount Stented bovine pericardial	21	24.9 ± 7.7	13.8 ± 4.0	1.3 ± 0.3
Baxter Perimount Stented bovine pericardial	23	19.9 ± 7.4	11.5 ± 3.9	1.6 ± 0.3
Baxter Perimount Stented bovine pericardial	25	16.5 ± 7.8	10.7 ± 3.8	1.6 ± 0.4
Baxter Perimount Stented bovine pericardial	27	12.8 ± 5.4	4.8 ± 2.2	2.0 ± 0.4
Biocor Stented porcine	23	30.0 ± 10.7	20 ± 6.6	1.3 ± 0.3
Biocor Stented porcine	25	23.0 ± 7.9	16 ± 5.1	1.7 ± 0.4
Biocor Stented porcine	27	22.0 ± 6.5	15.0 ± 3.7	2.2 ± 0.4
Extended Biocor Stentless	19-21	17.5 ± 6.5	9.6 ± 3.6	1.4 ± 0.4
Extended Biocor Stentless	23	14.7 ± 7.3	7.7 ± 3.8	1.7 ± 0.4
Extended Biocor Stentless	25	14.0 ± 4.3	7.4 ± 2.5	1.8 ± 0.4
Bioflo Stented bovine pericardial	19	37.2 ± 8.8	26.4 ± 5.5	0.7 ± 0.1
Bioflo Stented bovine pericardial	21	28.7 ± 6.2	18.7 ± 5.5	1.1 ± 0.1
Bjork-Shiley Single tilting disk	21	38.9 ± 11.9	21.8 ± 3.4	1.1 ± 0.3
Bjork-Shiley Single tilting disk	23	28.8 ± 11.2	15.7 ± 5.3	1.3 ± 0.3
Bjork-Shiley Single tilting disk	25	23.7 ± 8.2	13.0 ± 5.0	1.5 ± 0.4
Bjork-Shiley Single tilting disk	27		10.0 ± 2.0	1.6 ± 0.3
Carbomedics reduced Bileaflet	19	43.4 ± 1.2	24.4 ± 1.2	1.2 ± 0.1
Carbomedics Standard Bileaflet	19	38.0 ± 12.8	18.9 ± 8.3	1.0 ± 0.3
Carbomedics Standard Bileaflet	21	26.8 ± 10.1	12.9 ± 5.4	1.5 ± 0.4
Carbomedics Standard Bileaflet	23	22.5 ± 7.4	11.0 ± 4.6	1.4 ± 0.3
Carbomedics Standard Bileaflet	25	19.6 ± 7.8	9.1 ± 3.5	1.8 ± 0.4
Carbomedics Standard Bileaflet	27	17.5 ± 7.1	7.9 ± 3.2	2.2 ± 0.2
Carbomedics Standard Bileaflet	29	9.1 ± 4.7	5.6 ± 3.0	3.2 ± 1.6
Carbomedics Tophat Bileaflet	21	30.2 ± 10.9	14.9 ± 5.4	1.2 ± 0.3
Carbomedics Tophat Bileaflet	23	24.2 ± 7.6	12.5 ± 4.4	1.4 ± 0.4
Carbomedics Tophat Bileaflet	25		9.5 ± 2.9	1.6 ± 0.32
Carpentier Edwards Pericardial Stented bovine pericardial	19	32.1 ± 3.4	24.2 ± 8.6	1.2 ± 0.3
Carpentier Edwards Pericardial Stented bovine pericardial	21	25.7 ± 9.9	20.3 ± 9.1	1.5 ± 0.4
Carpentier Edwards Pericardial Stented bovine pericardial	23	21.7 ± 8.6	13.0 ± 5.3	1.8 ± 0.3
Carpentier Edwards Pericardial Stented bovine pericardial	25	16.5 ± 5.4	9.0 ± 2.3
Carpentier Edwards Standard Stented porcine	19	43.5 ± 12.7	25.6 ± 8.0	0.9 ± 0.2
Carpentier Edwards Standard Stented porcine	21	27.7 ± 7.6	17.3 ± 6.2	1.5 ± 0.3
Carpentier Edwards Standard Stented porcine	23	28.9 ± 7.5	16.1 ± 6.2	1.7 ± 0.5
Carpentier Edwards Standard Stented porcine	25	24.0 ± 7.1	12.9 ± 4.6	1.9 ± 0.5
Carpentier Edwards Standard Stented porcine	27	22.1 ± 8.2	12.1 ± 5.5	2.3 ± 0.6
Carpentier Edwards Standard Stented porcine	29		9.9 ± 2.9	2.8 ± 0.5
Carpentier Supra-Annular Stented porcine	19	34.1 ± 2.7		1.1 ± 0.1
Carpentier Supra-Annular Stented porcine	21	28.0 ± 10.5	17.5 ± 3.8	1.4 ± 0.9
Carpentier Supra-Annular Stented porcine	23	25.3 ± 10.5	13.4 ± 4.5	1.6 ± 0.6
Carpentier Supra-Annular Stented porcine	25	24.4 ± 7.6	13.2 ± 4.8	1.8 ± 0.4
Carpentier Supra-Annular Stented porcine	27	16.7 ± 4.7	8.8 ± 2.8	1.9 ± 0.7
Cryolife Stentless	19		9.0 ± 2.0	1.5 ± 0.3
Cryolife Stentless	21		6.6 ± 2.9	1.7 ± 0.4
Cryolife Stentless	23		6.0 ± 2.3	2.3 ± 0.2
Cryolife Stentless	25		6.1 ± 2.6	2.6 ± 0.2
Cryolife Stentless	27		4.0 ± 2.4	2.8 ± 0.3
Edwards Duromedics Bileaflet	21	39.0 ± 13
Edwards Duromedics Bileaflet	23	32.0 ± 8.0
Edwards Duromedics Bileaflet	25	26.0 ± 10.0
Edwards Duromedics Bileaflet	27	24.0 ± 10.0
Edwards Inspiris Resilia	19		17.6 ± 7.8	1.1 ± 0.2
Edwards Inspiris Resilia	21		12.6 ± 4.7	1.3 ± 0.3
Edwards Inspiris Resilia	23		10.1 ± 3.8	1.6 ± 0.4
Edwards Inspiris Resilia	25		9.6 ± 5.2	1.8 ± 0.5
Edwards Inspiris Resilia	27		8.2 ± 3.5	2.2 ± 0.6
Edwards Intuity	19		13.9 ± 3.9	1.1 ± 0.1
Edwards Intuity	21		11.6 ± 3.6	1.3 ± 0.1
Edwards Intuity	23		10.4 ± 3.5	1.7 ± 0.2
Edwards Intuity	25		9.1 ± 3.2	1.9 ± 0.2
Edwards Intuity	27		8.3 ± 3.7	2.2 ± 0.2
Edwards Mira Bileaflet	19		18.2 ± 5.3	1.2 ± 0.4
Edwards Mira Bileaflet	21		13.3 ± 4.3	1.6 ± 0.4
Edwards Mira Bileaflet	23		14.7 ± 2.8	1.6 ± 0.6
Edwards Mira Bileaflet	25		13.1 ± 3.8	1.9
Edwards Mosaic	21		13.3 ± 5.3	1.4 ± 0.4
Edwards Mosaic	23		11.8 ± 4.9	1.6 ± 0.5
Edwards Mosaic	25		10.6 ± 4.4	1.8 ± 0.5
Edwards Mosaic	27		9.1 ± 4.0	2.0 ± 0.5
Edwards Mosaic	29		8.6 ± 2.9	2.3 ± 0.6
Hancock Stented porcine	21	18.0 ± 6.0	12.0 ± 2.0
Hancock Stented porcine	23	16.0 ± 2.0	11.0 ± 2.0
Hancock Stented porcine	25	15.0 ± 3.0	10.0 ± 3.0
Hancock II Stented porcine	21		14.8 ± 4.1	1.3 ± 0.4
Hancock II Stented porcine	23	34.0 ± 13.0	16.6 ± 8.5	1.3 ± 0.4
Hancock II Stented porcine	25	22.0 ± 5.3	10.8 ± 2.8	1.6 ± 0.4
Hancock II Stented porcine	29	16.2 ± 1.5	8.2 ± 1.7	1.6 ± 0.2
Homograft Homograft valves	17-19		9.7 ± 4.2	4.2 ± 1.8
Homograft Homograft valves	19-21			5.4 ± 0.9
Homograft Homograft valves	20-21		7.9 ± 4.0	3.6 ± 2.0
Homograft Homograft valves	20-22		7.2 ± 3.0	3.5 ± 1.5
Homograft Homograft valves	22	1.7 ± 0.3		5.8 ± 3.2
Homograft Homograft valves	22-23		5.6 ± 3.1	2.6 ± 1.4
Homograft Homograft valves	22-24			5.6 ± 1.7
Homograft Homograft valves	24-27		6.2 ± 2.6	2.8 ± 1.1
Homograft Homograft valves	26	1.4 ± 0.6		6.8 ± 2.9
Homograft Homograft valves	25-28			6.2 ± 2.5
Intact Stented porcine	19	40.4 ± 15.4	24.5 ± 9.3
Intact Stented porcine	21	40.9 ± 15.6	19.6 ± 8.1	1.6 ± 0.4
Intact Stented porcine	23	32.7 ± 9.6	19.0 ± 6.1	1.6 ± 0.4
Intact Stented porcine	25	29.7 ± 15.0	17.7 ± 7.9	1.7 ± 0.3
Intact Stented porcine	27	25.0 ± 7.6	15.0 ± 4.5
Ionescu-Shiley Stented bovine pericardial	17	23.8 ± 3.4		0.9 ± 0.1
Ionescu-Shiley Stented bovine pericardial	19	19.7 ± 5.9	13.3 ± 3.9	1.1 ± 0.1
Ionescu-Shiley Stented bovine pericardial	21	26.6 ± 9.0
Ionescu-Shiley Stented bovine pericardial	23		15.6 ± 4.4
Labcor Santiago Stented bovine pericardial	19	18.6 ± 5.0	11.8 ± 3.3	1.2 ± 0.1
Labcor Santiago Stented bovine pericardial	21	17.5 ± 6.6	8.2 ± 4.5	1.3 ± 0.1
Labcor Santiago Stented bovine pericardial	23	14.8 ± 5.2	7.8 ± 2.9	1.8 ± 0.2
Labcor Santiago Stented bovine pericardial	25	12.3 ± 3.4	6.8 ± 2.0	2.1 ± 0.3
Labcor Synergy Stented porcine	21	24.3 ± 8.1	13.3 ± 4.2	1.1 ± 0.3
Labcor Synergy Stented porcine	23	27.3 ± 13.7	15.3 ± 6.9	1.4 ± 0.4
Labcor Synergy Stented porcine	25	22.5 ± 11.9	13.2 ± 6.4	1.5 ± 0.4
Labcor Synergy Stented porcine	27	17.8 ± 7.0	10.6 ± 4.6	1.8 ± 0.5
MCRI On-X Bileaflet	19	21.3 ± 10.8	11.8 ± 3.4	1.5 ± 0.2
MCRI On-X Bileaflet	21	16.4 ± 5.9	9.9 ± 3.6	1.7 ± 0.4
MCRI On-X Bileaflet	23	15.9 ± 6.4	8.6 ± 3.4	1.9 ± 0.6
MCRI On-X Bileaflet	25	16.5 ± 10.2	6.9 ± 4.3	2.4 ± 0.6
Medtronic Advantage Bileaflet	23		10.4 ± 3.1	2.2 ± 0.3
Medtronic Advantage Bileaflet	25		9.0 ± 3.7	2.8 ± 0.6
Medtronic Advantage Bileaflet	27		7.6 ± 3.6	3.3 ± 0.7
Medtronic Advantage Bileaflet	29		6.1 ± 3.8	3.9 ± 0.7
Medtronic Avalus	19		17.1 ± 5.0	1.11 ± 0.25
Medtronic Avalus	21		14.5 ± 4.3	1.25 ± 0.25
Medtronic Avalus	23		12.1 ± 3.8	1.47 ± 0.32
Medtronic Avalus	25		11.7 ± 4.0	1.57 ± 0.31
Medtronic Avalus	27		10.3 ± 4.2	1.77 ± 0.41
Medtronic Freestyle Stentless	19		13.0 ± 3.9
Medtronic Freestyle Stentless	21		9.1 ± 5.1	1.4 ± 0.3
Medtronic Freestyle Stentless	23	11.0 ± 4.0	8.1 ± 4.6	1.7 ± 0.5
Medtronic Freestyle Stentless	25		5.3 ± 3.1	2.1 ± 0.5
Medtronic Freestyle Stentless	27		4.6 ± 3.1	2.5 ± 0.1
Medtronic-Hall Single tilting disk	21	26.9 ± 10.5	14.1 ± 5.9	1.1 ± 0.2
Medtronic-Hall Single tilting disk	23	26.9 ± 8.9	13.5 ± 4.8	1.4 ± 0.4
Medtronic-Hall Single tilting disk	25	17.1 ± 7.0	9.5 ± 4.3	1.5 ± 0.5
Medtronic-Hall Single tilting disk	27	18.9 ± 9.7	8.7 ± 5.6	1.9 ± 0.2
Medtronic-Hall Single tilting disk	20	34.4 ± 13.1	17.1 ± 5.3	1.2 ± 0.5
Medtronic Mosaic Stented porcine	21		14.2 ± 5.0	1.4 ± 0.4
Medtronic Mosaic Stented porcine	23	23.8 ± 11.0	13.7 ± 4.8	1.5 ± 0.4
Medtronic Mosaic Stented porcine	25	22.5 ± 10.0	11.7 ± 5.1	1.8 ± 0.5
Medtronic Mosaic Stented porcine	27		10.4 ± 4.3	1.9 ± 0.1
Medtronic Mosaic Stented porcine	29		11.1 ± 4.3	2.1 ± 0.2
Mitroflow Stented bovine pericardial	19	18.6 ± 5.3	13.1 ± 3.3	1.1 ± 0.2
Monostrut Bjork-Shiley Single tilting disk	19		27.4 ± 8.8
Monostrut Bjork-Shiley Single tilting disk	21	27.5 ± 3.1	20.5 ± 6.2
Monostrut Bjork-Shiley Single tilting disk	23	20.3 ± 0.7	17.4 ± 6.4
Monostrut Bjork-Shiley Single tilting disk	25		16.1 ± 4.9
Monostrut Bjork-Shiley Single tilting disk	27		11.4 ± 3.8
Prima Stentless	21	28.8 ± 6.0	13.7 ± 1.9	1.4 ± 0.7
Prima Stentless	23	21.5 ± 7.5	11.5 ± 4.9	1.5 ± 0.3
Prima Stentless	25	22.1 ± 12.5	11.6 ± 7.2	1.8 ± 0.5
Omnicarbon Single tilting disk	21	37.4 ± 12.8	20.4 ± 5.4	1.3 ± 0.5
Omnicarbon Single tilting disk	23	28.8 ± 9.1	17.4 ± 4.9	1.5 ± 0.3
Omnicarbon Single tilting disk	25	23.7 ± 8.1	13.2 ± 4.6	1.9 ± 0.5
Omnicarbon Single tilting disk	27	20.1 ± 4.2	12.4 ± 2.9	2.1 ± 0.4
Omniscience Single tilting disk	21	50.8 ± 2.8	28.2 ± 2.2	0.9 ± 0.1
Omniscience Single tilting disk	23	39.8 ± 8.7	20.1 ± 5.1	1.0 ± 0.1
Starr-Edwards Caged ball	23	32.6 ± 12.8	22.0 ± 9.0	1.1 ± 0.2
Starr-Edwards Caged ball	24	34.1 ± 10.3	22.1 ± 7.5	1.1 ± 0.3
Starr-Edwards Caged ball	26	31.8 ± 9.0	19.7 ± 6.1
Starr-Edwards Caged ball	27	30.8 ± 6.3	18.5 ± 3.7
Starr-Edwards Caged ball	29	29.0 ± 9.3	16.3 ± 5.5
Sorin Bicarbon Bileaflet	19	30.1 ± 4.5	16.7 ± 2.0	1.4 ± 0.1
Sorin Bicarbon Bileaflet	21	22.0 ± 7.1	10.0 ± 3.3	1.2 ± 0.4
Sorin Bicarbon Bileaflet	23	16.8 ± 6.1	7.7 ± 3.3	1.5 ± 0.2
Sorin Bicarbon Bileaflet	25	11.2 ± 3.1	5.6 ± 1.6	2.4 ± 0.3
Sorin Pericarbon Stentless	19	36.5 ± 9.0	28.9 ± 7.3	1.2 ± 0.5
Sorin Pericarbon Stentless	21	28.0 ± 13.3	23.8 ± 11.1	1.3 ± 0.6
Sorin Pericarbon Stentless	23	27.5 ± 11.5	23.2 ± 7.6	1.5 ± 0.5
Sorin Perceval Sutureless	S (21)		10.1 ± 4.2	1.3 ± 0.3
Sorin Perceval Sutureless	M (23)		9.4 ± 5.5	1.5 ± 0.4
Sorin Perceval Sutureless	L (25)		8.5 ± 4.6	1.5 ± 0.4
Sorin Perceval Sutureless	XL (27)		9.7 ± 4.7	1.6 ± 0.4
St. Jude Medical Haem Plus Bileaflet	19	28.5 ± 10.7	17.0 ± 7.8	1.9 ± 0.1
St. Jude Medical Haem Plus Bileaflet	21	16.3 ± 17.0	10.6 ± 5.1)	1.8 ± 0.5
St. Jude Medical Haem Plus Bileaflet	23	16.8 ± 7.3	12.1 ± 4.2	1.7 ± 0.5
St. Jude Medical Regent Bileaflet	19	20.6 ± 12	11.0 ± 4.9	1.6 ± 0.4
St. Jude Medical Regent Bileaflet	21	15.6 ± 9.4	8.0 ± 4.8	2.0 ± 0.7
St. Jude Medical Regent Bileaflet	23	12.8 ± 6.8	6.9 ± 3.5	2.3 ± 0.9
St. Jude Medical Regent Bileaflet	25	11.7 ± 6.8	5.6 ± 3.2	2.5 ± 0.8
St. Jude Medical Regent Bileaflet	27	7.9 ± 5.5	3.5 ± 1.7	3.6 ± 0.5
St. Jude Medical Standard Bileaflet	19	42.0 ± 10.0	24.5 ± 5.8	1.5 ± 0.1
St. Jude Medical Standard Bileaflet	21	25.7 ± 9.5	15.2 ± 5.0	1.4 ± 0.4
St. Jude Medical Standard Bileaflet	23	21.8 ± 7.5	13.4 ± 5.6	1.6 ± 0.4
St. Jude Medical Standard Bileaflet	25	18.9 ± 7.3	11.0 ± 5.3	1.9 ± 0.5
St. Jude Medical Standard Bileaflet	27	13.7 ± 4.2	8.4 ± 3.4	2.5 ± 0.4
St. Jude Medical Standard Bileaflet	29	13.5 ± 5.8	7.0 ± 1.7	2.8 ± 0.5
St. Jude Medical Stentless	21	22.6 ± 14.5	10.7 ± 7.2	1.3 ± 0.6
St. Jude Medical Stentless	23	16.2 ± 9.0	8.2 ± 4.7	1.6 ± 0.6
St. Jude Medical Stentless	25	12.7 ± 8.2	6.3 ± 4.1	1.8 ± 0.5
St. Jude Medical Stentless	27	10.1 ± 5.8	5.0 ± 2.9	2.0 ± 0.3
St. Jude Medical Stentless	29	7.7 ± 4.4	4.1 ± 2.4	2.4 ± 0.6

Modified from Rajani 2007 (guideline ref 231)

Mitral

When to suspect stenosis, Adult-Derived · ASE 2024, Table 11
Measure	Normal	Possible stenosis	Suggests significant stenosis
Peak velocity (m/s)	<1.9	1.9–2.5	≥2.5
Mean gradient (mmHg)	≤5	6–10	>10
VTI_PrMV / VTI_LVOT	<2.2	2.2–2.5	>2.5
EOA (cm²)	≥2.0	1–2	<1
PHT (ms)	<130	130–200	>200

Some normal values cross these cut-offs

PPM, Adult-Derived · ASE 2024, Table 7
Indexed EOA (cm²/m²)	Normal	Moderate	Severe
BMI <30 kg/m²	>1.2	1.2–0.91	≤0.90
BMI ≥30 kg/m²	>1.0	1.0–0.76	≤0.75

Table A5 · Surgical mitral valves · 122 rows Adult

Table A5. Normal Doppler echocardiographic values for surgical prosthetic mitral valves. Mean ± SD. ASE 2024, Appendix.

Valve	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	Peak velocity (m/s)	PHT (ms)	EOA (cm²)
Abbott Epic	27		6.1 ± 2.9			1.4 ± 0.7
Abbott Epic	29		5.5 ± 1.7			1.5 ± 0.5
Abbott Epic	31		4.8 ± 1.4			1.6 ± 0.3
Abbott Epic	33		4.1 ± 1.6			1.5 ± 0.3
Biocor Stentless bioprosthesis	27	13 ± 1
Biocor Stentless bioprosthesis	29	14 ± 2.5
Biocor Stentless bioprosthesis	31	11.5 ± 0.5
Biocor Stentless bioprosthesis	33	12 ± 0.5
Bioflo pericardial Stented bioprosthesis	25	10 ± 2	6.3 ± 1.5			2 ± 0.1
Bioflo pericardial Stented bioprosthesis	27	9.5 ± 2.6	5.4 ± 1.2			2 ± 0.3
Bioflo pericardial Stented bioprosthesis	29	5 ± 2.8	3.6 ± 1			2.4 ± 0.2
Bioflo pericardial Stented bioprosthesis	31	4.0	2.0			2.3
Bjork-Shiley Tilting disk	23			1.7	115
Bjork-Shiley Tilting disk	25	12 ± 4	6 ± 2	1.75 ± 0.38	99 ± 27	1.72 ± 0.6
Bjork-Shiley Tilting disk	27	10 ± 4	5 ± 2	1.6 ± 0.49	89 ± 28	1.81 ± 0.54
Bjork-Shiley Tilting disk	29	7.83 ± 2.93	2.83 ± 1.27	1.37 ± 0.25	79 ± 17	2.1 ± 0.43
Bjork-Shiley Tilting disk	31	6 ± 3	2 ± 1.9	1.41 ± 0.26	70 ± 14	2.2 ± 0.3
Bjork-Shiley monostrut Tilting disk	23		5.0	1.9
Bjork-Shiley monostrut Tilting disk	25	13 ± 2.5	5.57 ± 2.3	1.8 ± 0.3
Bjork-Shiley monostrut Tilting disk	27	12 ± 2.5	4.53 ± 2.2	1.7 ± 0.4
Bjork-Shiley monostrut Tilting disk	29	13 ± 3	4.26 ± 1.6	1.6 ± 0.3
Bjork-Shiley monostrut Tilting disk	31	14 ± 4.5	4.9 ± 1.6	1.7 ± 0.3
Carbomedics Bileaflet	23			1.9 ± 0.1	126 ± 7
Carbomedics Bileaflet	25	10.3 ± 2.3	3.6 ± 0.6	1.3 ± 0.1	93 ± 8	2.9 ± 0.8
Carbomedics Bileaflet	27	8.79 ± 3.46	3.46 ± 1.03	1.61 ± 0.3	89 ± 20	2.9 ± 0.75
Carbomedics Bileaflet	29	8.78 ± 2.9	3.39 ± 0.97	1.52 ± 0.3	88 ± 17	2.3 ± 0.4
Carbomedics Bileaflet	31	8.87 ± 2.34	3.32 ± 0.87	1.61 ± 0.29	92 ± 24	2.8 ± 1.14
Carbomedics Bileaflet	33	8.8 ± 2.2	4.8 ± 2.5	1.5 ± 0.2	93 ± 12
Carpentier-Edwards Stented bioprosthesis	27		6 ± 2	1.7 ± 0.3	98 ± 28
Carpentier-Edwards Stented bioprosthesis	29		4.7 ± 2	1.76 ± 0.27	92 ± 14
Carpentier-Edwards Stented bioprosthesis	31		4.4 ± 2	1.54 ± 0.15	92 ± 19
Carpentier-Edwards Stented bioprosthesis	33		6 ± 3		93 ± 12
Carpentier-Edwards pericardial Stented Bioprosthesis	27		3.6	1.6	100
Carpentier-Edwards pericardial Stented Bioprosthesis	29		5.25 ± 2.36	1.67 ± 0.3	110 ± 15
Carpentier-Edwards pericardial Stented Bioprosthesis	31		4.05 ± 0.83	1.53 ± 0.1	90 ± 11
Carpentier-Edwards pericardial Stented Bioprosthesis	33		1.0	0.8	80
Carpentier-Edwards Perimount Stented pericardial	25		4.0 ± 1.0	1.7 ± 0.10	67 ± 21.5	1.75 ± 0.53
Carpentier-Edwards Perimount Stented pericardial	27		6.3 ± 1.65	1.7 ± 0.27	74 ± 20.6	1.88 ± 0.52
Carpentier-Edwards Perimount Stented pericardial	29		6.0 ± 1.41	1.8 ± 0.19	76 ± 17.9	2.02 ± 0.57
Carpentier-Edwards Perimount Stented pericardial	31		5.5 ± 1.06	1.8 ± 0.20	80 ± 21.8	2.09 ± 0.48
Carpentier-Edwards Perimount Stented pericardial	33		6.1 ± 1.86	1.7 ± 0.23	77 ± 13.2	2.24 ± 0.97
Duromedics Bileaflet	27	13 ± 6	5 ± 3	1.61 ± 0.4	75 ± 12
Duromedics Bileaflet	29	10 ± 4	3 ± 1	1.40 ± 0.25	85 ± 22
Duromedics Bileaflet	31	10.5 ± 4.33	3.3 ± 1.36	1.38 ± 0.27	81 ± 12
Duromedics Bileaflet	33	11.2	2.5		85
Edwards Mitris	25		4.9 ± 1.2			1.1 ± 0.4
Edwards Mitris	27		4.1 ± 1.4			1.2 ± 0.3
Edwards Mitris	29		4.1 ± 1.5			1.5 ± 0.6
Edwards Mitris	31		3.9 ± 2.0			1.4 ± 0.5
Edwards Mitris	33		3.3 ± 1.4			1.5 ± 0.7
Hancock I or not specified Stented bioprosthesis	27	10 ± 4	5 ± 2			1.3 ± 0.8
Hancock I or not specified Stented bioprosthesis	29	7 ± 3	2.46 ± 0.79		115 ± 20	1.5 ± 0.2
Hancock I or not specified Stented bioprosthesis	31	4 ± 0.86	4.86 ± 1.69		95 ± 17	1.6 ± 0.2
Hancock I or not specified Stented bioprosthesis	33	3 ± 2	3.87 ± 2		90 ± 12	1.9 ± 0.2
Hancock II Stented bioprosthesis	25		8.3 ± 1.71	2.1 ± 0.28	76 ± 19.8	1.42 ± 0.29
Hancock II Stented bioprosthesis	27		6.1 ± 1.33	2 ± 0.28	81 ± 18.9	1.62 ± 0.47
Hancock II Stented bioprosthesis	29		6.7 ± 2.20	2.0 ± 0.31	77 ± 15.1	1.83 ± 0.68
Hancock II Stented bioprosthesis	31		6.0 ± 1.58	2.0 ± 0.32	76 ± 12.1	1.70 ± 0.41
Hancock II Stented bioprosthesis	33		5.5 ± 1.64	1.9 ± 0.50	65 ± 8.7	2.71 ± 0.77
Hancock pericardial Stented bioprosthesis	29		2.61 ± 1.39	1.42 ± 0.14	105 ± 36
Hancock pericardial Stented bioprosthesis	31		3.57 ± 1.02	1.51 ± 0.27	81 ± 23
Ionescu-Shiley Stented bioprosthesis	25		4.87 ± 1.08	1.43 ± 0.15	93 ± 11
Ionescu-Shiley Stented bioprosthesis	27		3.21 ± 0.82	1.31 ± 0.24	100 ± 28
Ionescu-Shiley Stented bioprosthesis	29		3.22 ± 0.57	1.38 ± 0.2	85 ± 8
Ionescu-Shiley Stented bioprosthesis	31		3.63 ± 0.9	1.45 ± 0.06	100 ± 36
Ionescu-Shiley low profile Stented bioprosthesis	29		3.31 ± 0.96	1.36 ± 0.25	80 ± 30
Ionescu-Shiley low profile Stented bioprosthesis	31		2.74 ± 0.37	1.33 ± 0.14	79 ± 15
Labcor-Santiago pericardial Stented bioprosthesis	25	8.7	4.5		97	2.2
Labcor-Santiago pericardial Stented bioprosthesis	27	5.6 ± 2.3	2.8 ± 1.5		85 ± 18	2.12 ± 0.48
Labcor-Santiago pericardial Stented bioprosthesis	29	6.2 ± 2.1	3 ± 1.3		80 ± 34	2.11 ± 0.73
Lillehei-Kaster Tilting disk	18			1.7	140
Lillehei-Kaster Tilting disk	20			1.7	67
Lillehei-Kaster Tilting disk	22			1.56 ± 0.09	94 ± 22
Lillehei-Kaster Tilting disk	25			1.38 ± 0.27	124 ± 46
Medtronic-Hall Tilting disk	27			1.4	78
Medtronic-Hall Tilting disk	29			1.57 ± 0.1	69 ± 15
Medtronic-Hall Tilting disk	31			1.45 ± 0.12	77 ± 17
Medtronic Intact Porcine Stented bioprosthesis	29		3.5 ± 0.51	1.6 ± 0.22
Medtronic Intact Porcine Stented bioprosthesis	31		4.2 ± 1.44	1.6 ± 0.26
Medtronic Intact Porcine Stented bioprosthesis	33		4 ± 1.3	1.4 ± 0.24
Medtronic Intact Porcine Stented bioprosthesis	35		3.2 ± 1.77	1.3 ± 0.5
Medtronic Mosaic	25		8.3 ± 1.71	2.1 ± 0.28	76 ± 19.8	1.42 ± 0.29
Medtronic Mosaic	27		6.1 ± 1.33	2 ± 0.28	81 ± 18.9	1.62 ± 0.47
Medtronic Mosaic	29		6.7 ± 2.20	2.0 ± 0.31	77 ± 15.1	1.83 ± 0.68
Medtronic Mosaic	31		6.0 ± 1.58	2.0 ± 0.32	76 ± 12.1	1.70 ± 0.41
Medtronic Mosaic	33		5.5 ± 1.64	1.9 ± 0.50	65 ± 8.7	2.71 ± 0.77
Mitroflow Stented bioprosthesis	25		6.9	2.0	90
Mitroflow Stented bioprosthesis	27		3.07 ± 0.91	1.5	90 ± 20
Mitroflow Stented bioprosthesis	29		3.5 ± 1.65	1.43 ± 0.29	102 ± 21
Mitroflow Stented bioprosthesis	31		3.85 ± 0.81	1.32 ± 0.26	91 ± 22
Omnicarbon Tilting disk	23		8.0
Omnicarbon Tilting disk	25		6.05 ± 1.81	1.77 ± 0.24	102 ± 16
Omnicarbon Tilting disk	27		4.89 ± 2.05	1.63 ± 0.36	105 ± 33
Omnicarbon Tilting disk	29		4.93 ± 2.16	1.56 ± 0.27	120 ± 40
Omnicarbon Tilting disk	31		4.18 ± 1.4	1.3 ± 0.23	134 ± 31
Omnicarbon Tilting disk	33		4 ± 2
On-X Bileaflet	25	11.5 ± 3.2	5.3 ± 2.1			1.9 ± 1.1
On-X Bileaflet	27-29	10.3 ± 4.5	4.5 ± 1.6			2.2 ± 0.5
On-X Bileaflet	31-33	9.8 ± 3.8	4.8 ± 2.4			2.5 ± 1.1
Sorin Allcarbon Tilting disk	25	15 ± 3	5 ± 1	2 ± 0.2	105 ± 29	2.2 ± 0.6
Sorin Allcarbon Tilting disk	27	13 ± 2	4 ± 1	1.8 ± 0.1	89 ± 14	2.5 ± 0.5
Sorin Allcarbon Tilting disk	29	10 ± 2	4 ± 1	1.6 ± 0.2	85 ± 23	2.8 ± 0.7
Sorin Allcarbon Tilting disk	31	9 ± 1	4 ± 1	1.6 ± 0.1	88 ± 27	2.8 ± 0.9
Sorin Bicarbon Bileaflet	25	15 ± 0.25	4 ± 0.5	1.95 ± 0.02	70 ± 1
Sorin Bicarbon Bileaflet	27	11 ± 2.75	4 ± 0.5	1.65 ± 0.21	82 ± 20
Sorin Bicarbon Bileaflet	29	12 ± 3	4 ± 1.25	1.73 ± 0.22	80 ± 14
Sorin Bicarbon Bileaflet	31	10 ± 1.5	4 ± 1	1.66 ± 0.11	83 ± 14
St. Jude Medical Bileaflet	23		4.0	1.5	160	1.0
St. Jude Medical Bileaflet	25		2.5 ± 1	1.34 ± 1.12	75 ± 4	1.35 ± 0.17
St. Jude Medical Bileaflet	27	11 ± 4	5 ± 1.82	1.61 ± 0.29	75 ± 10	1.67 ± 0.17
St. Jude Medical Bileaflet	29	10 ± 3	4.15 ± 1.8	1.57 ± 0.29	85 ± 10	1.75 ± 0.24
St. Jude Medical Bileaflet	31	12 ± 6	4.46 ± 2.22	1.59 ± 0.33	74 ± 13	2.03 ± 0.32
Starr-Edwards Caged ball	26		10.0			1.4
Starr-Edwards Caged ball	28		7 ± 2.75			1.9 ± 0.57
Starr-Edwards Caged ball	30	12.2 ± 4.6	6.99 ± 2.5	1.7 ± 0.3	125 ± 25	1.65 ± 0.4
Starr-Edwards Caged ball	32	11.5 ± 4.2	5.08 ± 2.5	1.7 ± 0.3	110 ± 25	1.98 ± 0.4
Starr-Edwards Caged ball	34		5.0			2.6
Stentless quadrileaflet bovine pericardial Stentless bioprosthesis	26		2.2 ± 1.7	1.6	103 ± 31	1.7
Stentless quadrileaflet bovine pericardial Stentless bioprosthesis	28			1.58 ± 0.25		1.7 ± 0.6
Stentless quadrileaflet bovine pericardial Stentless bioprosthesis	30			1.42 ± 0.32		2.3 ± 0.4
Wessex Stented bioprosthesis	29		3.69 ± 0.61	1.66 ± 0.17	83 ± 19
Wessex Stented bioprosthesis	31		3.31 ± 0.83	1.41 ± 0.25	80 ± 21

Modified from Rosenhek 2003 (guideline ref 232)

Table A6 · SAPIEN valves in the mitral position · 6 rows Adult

Table A6. Mean Doppler echocardiographic gradients for normal SAPIEN Valves placed percutaneously in the mitral position. Mean gradient (mmHg), median (IQR) or mean ± SD. NA, not applicable; ViV, valve-in-valve; ViR, valve-in-ring; ViMAC, valve-in-mitral annular calcification. ASE 2024, Appendix.

Reference and valve size	ViV	ViR	ViMAC	All
Guerrero et al.	7 (6-9)	7 (6-9)	6 (4-8)	7 (5-9)
Whisenant et al.	7.3 ± 2.73	NA	NA	NA
Eleid et al.	5.7 ± 2.5	5.7 ± 2.2	4.3 ± 2.3	5.5 ± 2.4
Eleid et al., 23 mm	6.4 ± 2.4	5 ± 2	8*	6.25 ± 2.2
Eleid et al., 26 mm	7.0 ± 2.6	6 ± 1.4	4*	6.5 ± 2.4
Eleid et al., 29 mm	4.9 ± 2.1	6 ± 3	2.5 ± 0.5	4.8 ± 2.3

Guerrero 2020, Whisenant 2020, Eleid 2016

Tricuspid

When to suspect stenosis, Adult-Derived · ASE 2024, Table 19 and text
Suggests stenosis	Bioprosthetic	Mechanical
Peak E velocity (m/s)	≥2.1	≥1.9
Mean gradient (mmHg)	≥9	≥6
PHT (ms)	≥200	≥130
EOA (cm²)	<1.5	<2.0
DVI (VTI_PrTV / VTI_LVOT)	≥3.3	≥2.1

Some normal values cross these cut-offs

Table A8 · Transcatheter tricuspid ViV and ViR · 3 rows Ages 1–86 y

Table A8. Transcatheter tricuspid ViV and ViR. NR, not reported. PVL, paravalvular leak. ASE 2024, Appendix.

Study	n	ViV/ViR	Age (y)	Mean gradient (mmHg, mean ± SD)	EOA (cm²)	Peak velocity (m/s)	PVL
McElhinney et al.	306	ViV, n = 284 (93%) ViR, n = 22 (7%)	40 (1-86)	3.8 ± 2.0	NR	NR	Trivial or none in 83%
McElhinney et al.				≥29 mm, 3.6 ± 1.8
McElhinney et al.				<29 mm, 4.2 ± 2.3

McElhinney 2019 (guideline ref 203)

Table A9 · Mechanical and bioprosthetic TVs · 28 rows Adult

Table A9. Normal Doppler echocardiographic values for prosthetic TVs. Mean ± SD. CON, continuity equation; iEOA, indexed EOA; MG, mean gradient; VTI, velocity-time integral; TVP, TV prosthesis. ASE 2024, Appendix.

Valve	Size (mm)	PHT (ms)	MG (mmHg)	E velocity (m/s)	VTI_TVP (cm)	VTI_TVP/VTI_LVOT	EOA CON (cm²)	iEOA CON (cm²/m²)
Mechanical
St. Jude Medical Standard	27	77 ± 14.6	2.4 ± 1.27	1.1 ± 0.32	25 ± 7.0	1.2 ± 0.33	2.54 ± 0.64	1.52 ± 0.34
St. Jude Medical Standard	29	100 ± 35.2	2.6 ± 1.13	1.2 ± 0.21	31 ± 6.5	1.4 ± 0.30	2.20 ± 0.33	1.21 ± 0.13
St. Jude Medical Standard	31	81 ± 13.5	3.3 ± 1.21	1.4 ± 0.31	30 ± 5.1	1.4 ± 0.23	2.49 ± 0.45	1.38 ± 0.29
St. Jude Medical Standard	33	82 ± 18.8	3.2 ± 1.24	1.3 ± 0.22	30 ± 7.8	1.5 ± 0.33	2.46 ± 0.59	1.36 ± 0.36
Carbomedics Standard	31	78	4.0 ± 1.63	1.4 ± 0.19	40 ± 11.4	1.9 ± 0.53	2.01 ± 0.51	1.04 ± 0.18
Carbomedics Standard	33	98 ± 9.7	3.4 ± 1.19	1.2 ± 0.16	34 ± 7.3	1.6 ± 0.33	2.33 ± 0.43	1.25 ± 0.35
Starr-Edwards	30	132	5	1.5	41	1.5	2.07	1.51
Starr-Edwards	32	NA	4.0 ± 1.0	1.5 ± 0.44	39 ± 14.2	2.0 ± 0.68	1.87 ± 0.33	0.96 ± 0.18
Starr-Edwards	34	118 ± 32.9	5.7 ± 1.63	1.8 ± 0.28	44 ± 7.8	1.9 ± 0.32	1.81 ± 0.48	1.08 ± 0.29
Bioprosthesis
Medtronic Mosaic	25	80	4.0	1.6	35	3.2	1.37	0.93
Medtronic Mosaic	27	NA	5.5 ± 0.53	1.6 ± 0.17	51 ± 6.8	2.2 ± 0.4	1.53 ± 0.16	0.86 ± 0.18
Medtronic Mosaic	29	115 ± 13.4	6.0 ± 2.0	1.5 ± 0.26	37 ± 0.97	1.8 ± 0.39	1.96 ± 0.39	1.12 ± 0.21
Medtronic Mosaic	31	144 ± 28.6	5.2 ± 1.43	1.5 ± 0.21	46 ± 9.5	2.2 ± 0.6	1.74 ± 0.52	0.95 ± 0.29
Medtronic Mosaic	33	139 ± 56.5	4.3 ± 1.3	1.4 ± 0.19	40 ± 8.6	2.1 ± 0.3	2.0 ± 0.53	1.01 ± 0.26
Carpentier Edwards Perimount	29	94 ± 2.8	2.0 ± 1.41	1.1 ± 0.21	29 ± 7.1	1.6 ± 0.20	2.16 ± 0.43	1.39 ± 0.42
Carpentier Edwards Perimount	31	74 ± 26.2	3.7 ± 1.53	1.2 ± 0.20	37 ± 9.1	1.7 ± 0.35	2.12 ± 0.53	1.20 ± 0.29
Carpentier Edwards Perimount	33	137 ± 53	3.9 ± 1.07	1.4 ± 0.21	38 ± 7.9	1.9 ± 0.28	1.93 ± 0.43	1.03 ± 0.19
Bioprosthesis
Carpentier Edwards Duraflex	27	130 ± 45.4	5.2 ± 1.69	1.5 ± 0.26	46 ± 8.0	2.4 ± 0.40	1.34 ± 0.22	0.78 ± 0.15
Carpentier Edwards Duraflex	29	102 ± 26.5	6.0 ± 1.95	1.7 ± 0.27	47 ± 9.6	2.3 ± 0.60	1.54 ± 0.38	0.88 ± 0.19
Carpentier Edwards Duraflex	31	115 ± 40.8	5.7 ± 1.67	1.5 ± 0.27	48 ± 9.0	2.3 ± 0.53	1.57 ± 0.39	0.88 ± 0.22
Carpentier Edwards Duraflex	33	116 ± 39.7	5.6 ± 2.10	1.5 ± 0.26	47 ± 10.2	2.3 ± 0.54	1.69 ± 0.44	0.92 ± 0.24
Carpentier Edwards Duraflex	35	83 ± 26.5	5.3 ± 1.61	1.5 ± 0.25	46 ± 10.5	2.3 ± 0.54	1.63 ± 0.38	0.88 ± 0.22
St. Jude Biocor	29	NA	6	1.6	43	1.7	2.84	1.54
St. Jude Biocor	31	106 ± 48.5	5.1 ± 1.36	1.5 ± 0.34	46 ± 12.5	2.2 ± 0.57	1.92 ± 0.53	0.99 ± 0.19
St. Jude Biocor	33	125 ± 45.7	3.9 ± 1.20	1.3 ± 0.23	39 ± 10	1.9 ± 0.56	1.88 ± 0.49	1.07 ± 0.29
Bioprosthesis
Medtronic Hancock II	31	NA	5.7 ± 1.37	1.6 ± 0.19	49 ± 8.7	2.3 ± 0.36	1.4 ± 0.21	0.77 ± 0.19
Medtronic Hancock II	33	NA	5.5 ± 3.54	1.4 ± 0.28	50 ± 16.3	2.9 ± 0.48	1.4 ± 0.59	0.71 ± 0.24
Medtronic Hancock II	35	NA	5.3 ± 0.58	1.3 ± 0.32	41 ± 2.5	1.8 ± 0.12	2.11 ± 0.23	1.01 ± 0.22

Data from Blauwet 2010 and 2011 (guideline refs 192, 202)

Key points

Compare with that valve's normal values and the patient's baseline study.
Aortic stenosis needs a flow-dependent and a flow-independent measure.
Pulmonary: locate the level with PW Doppler; Table 15 and Table A7 differ for bioprostheses.
Children: PPM is inevitable with growth; no pediatric-specific PPM cut-offs.
Prosthetic regurgitation grading is not covered here.

Sources and how this page was checked

Guideline (full text read)

Zoghbi WA, Jone PN, Chamsi-Pasha MA, et al. Guidelines for the evaluation of prosthetic valve function with cardiovascular imaging: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024;37:2-63. doi:10.1016/j.echo.2023.10.004. Read in full (62 pages) in October 2026; citation details checked against Crossref.
Blauwet LA, Burkhart HM, Dearani JA, et al. Comprehensive echocardiographic assessment of mechanical tricuspid valve prostheses based on early post-implantation echocardiographic studies. J Am Soc Echocardiogr 2011;24(4):414-424. doi:10.1016/j.echo.2010.12.021. The guideline’s source for the Table A9 mechanical valves (ref 202); publisher PDF read in full in November 2026. Its Tables 1–3 match every Table A9 mechanical value and give the 30-mm column as Starr-Edwards.

Credits for the appendix tables (source studies cited by the guideline; not read unless noted)

Tables A1 and A2: modified from Hahn RT, Leipsic J, Douglas PS, et al. Comprehensive echocardiographic assessment of normal transcatheter valve function. JACC Cardiovasc Imaging 2019;12:25-34 (ref 11), with permission.
Table A3: derived from the respective publications (refs 100, 141, 229, 230, as printed; ref 141 is a transcatheter mitral study).
Table A4: modified from Rajani R, Mukherjee D, Chambers JB. Doppler echocardiography in normally functioning replacement aortic valves: a review of 129 studies. J Heart Valve Dis 2007;16:519-35 (ref 231).
Table A5: modified from Rosenhek R, Binder T, Maurer G, et al. Normal values for Doppler echocardiographic assessment of heart valve prostheses. J Am Soc Echocardiogr 2003;16:1116-27 (ref 232).
Table A6: Guerrero 2020 (ref 139), Whisenant 2020 (ref 138) and Eleid 2016 (ref 140); per-size values computed from Eleid.
Table A7: Egbe 2019 (ref 233), Jalal 2021 (ref 234), Hahn 2019 (ref 11), Shojaeifard 2020 (ref 235).
Table A8: McElhinney DB, Aboulhosn JA, Dvir D, et al. Mid-term valve-related outcomes after transcatheter tricuspid valve-in-valve or valve-in-ring replacement. J Am Coll Cardiol 2019;73:148-57 (ref 203).
Table A9: Blauwet LA, et al. J Am Soc Echocardiogr 2010;23:1045-59 (ref 192, bioprostheses, not read) and 2011;24:414-24 (ref 202, mechanical valves, read: see above).

How it was checked

Every row of Appendix Tables A1–A9 is reproduced (A1 15, A2 10, A3 4, A4 211, A5 122, A6 6, A7 26, A8 3, A9 28 rows): cells were compared one by one with the PDF and with rendered pages. Tables A1, A2, A4–A7 and A9 give the values reported for normally functioning prostheses (mean ± SD, or median with IQR where marked; A7's “<” entries are limits); A3 reports aortic valve-in-valve at 1 year and A8 a cohort after tricuspid valve-in-valve or valve-in-ring. None is a cut-off for an individual patient.
Layout: Tables A1, A2 and A9 print sizes across the table; here each size is a row. Spacing around ± is standardised and units are written m/s, mmHg and ms (the guideline prints m/sec, mm Hg, msec). Names are as printed: in Tables A4 and A5 the second line (valve type or model) is italic, as in the guideline; Table A9's Mechanical and Bioprosthesis are block headings; its 30-mm mechanical column, printed between the Carbomedics Standard and Starr-Edwards headings, is shown under Starr-Edwards, as in Blauwet 2011.
The criteria tables (Tables 5, 6, 7, 11, 15, 19) are condensed in our words with every number as printed; terms and abbreviations follow the guideline (EOA, DVI, AT, PHT, PPM for prosthesis-patient mismatch, SAVR, TAVI, ViV, ViR, ViMAC).
Adult label: the guideline presents its approach as one developed in adults (Section VI). Tables A1–A6 and A9 are labelled Adult; the guideline gives no ages for them. Table A7 has mixed sources: Egbe 2019 (adults with congenital heart disease), Jalal 2021 (folded Melody technique), Shojaeifard 2020 (mechanical pulmonary prostheses) and, for SAPIEN, Hahn 2019, the source of Tables A1 and A2 (transcatheter valves in native aortic stenosis). Table A8 prints ages 1–86 years.
Inconsistencies in the source, shown as printed: Table 15 and Table A7 give different normal limits for bioprosthetic pulmonary valves; Figure 13 (aortic algorithm) uses DVI ≥0.30, 0.29–0.25 and <0.25, while Table 5 uses >0.35, 0.25–0.35 and <0.25; in Table 11, peak velocity 2.5 m/s and EOA 2.0 cm² each fall in two columns, and a mean gradient between 5 and 6 mmHg in neither; Table 19 gives DVI ≥2.1 (mechanical) and ≥3.3 (bioprosthetic) as suggesting stenosis, while the text gives normal upper values of 2.3–2.8 and 2.4–3.6.
Not covered: prosthetic regurgitation grading (Tables 8, 12 except the MR clue, 13, 16, 20, 21), CT and CMR (Tables 2, 3, 9, 17, 24) and the figure algorithms.

Pulmonary

Aortic

Mitral

Tricuspid

Key points

Related on HeartCalc

Guideline (full text read)

Credits for the appendix tables (source studies cited by the guideline; not read unless noted)

How it was checked