Transradial measurement of transvalvular pressure gradient in the setting of mechanical aortic and mitral valve prostheses using a coronary fractional flow reserve guidewire

Accurate measurement of transvalvular pressure gradients is essential to comprehensively evaluate whether mechanical prosthetic valves are functioning normally. Direct measurements can be technically complicated, traditionally requiring direct, transapical puncture in the setting of both aortic and mitral mechanical valve prostheses. Very few case reports have proposed the use of guidewires indicated for coronary fractional flow reserve assessment to evaluate the transvalvular pressure gradients and hemodynamic status of patients with both aortic and mitral valve mechanical prostheses. We present one such case of a 59-year-old male with history of rheumatic heart disease and double mechanical valve replacements of the aortic and mitral valves presenting with contradictory clinical signs and noninvasive testing evidence of decompensated congestive heart failure and possible dysfunction of a mechanical, bi-leaflet aortic valve prosthesis. The use of a low-profile, intracoronary guidewire with a pressure transducer near the distal tip indicated for coronary fractional flow reserve determination proved very useful to answer this important question. Additionally, we report the first case of the use of this technology for this purpose via the radial artery access approach.