.
Stress echocardiography can be useful to evaluate symptoms in patients
with prosthetic valves,60 especially when there is discrepancy between
the resting valve hemodynamics and the patient’s symptoms.
Normally and abnormally functioning prosthetic valves can have similar transvalvular gradients at rest.61
Symptoms can develop from prosthetic stenosis or regurgitation, PPM, coronary stenoses, or pulmonary diseases,
and these can be assessed during stress echocardiography.
As hemodynamics can return rapidly to baseline following treadmill stress, supine
bicycle and pharmacologic stress with dobutamine are preferable modalities;
both allow the assessment of valvular hemodynamics during
stress and at peak stress.
.
Exercise is generally preferred over pharmacologic stress
because of its physiologic response, important in these clinical circumstances.
.
In general, the assessment for valve obstruction should be similar to that of native valve stenosis, and details regarding
stress protocols have been previously described
