With mechanical valve obstruction, fluoroscopy or CT imaging can also be helpful for detection of reduced motion caused by pannus ingrowth or thrombus. 4. Studies based on TTE follow-up estimate that approximately 30% of patients with a surgical aortic valve bioprosthesis develop evidence of valve dysfunction over the 10 years after implan- tation (defined as an increase in mean gradient of 10 mmHg or a worsening of transprosthetic regurgitation from mild to moderate or from moderate to severe).9 The incidence of clinically important structural valve deterioration increases markedly more than 10 years after surgery, such that routine annual TTE studies thereafter are rea- Risk factors associated with acceler- ated (<5 years) valve deterioration include young age (<60 years) at implantation, smoking, diabe- tes mellitus, chronic kidney disease, initial mean gradient 15 mmHg, and valve type.9,12 The selec- tive adoption of an earlier, annual TTE screening program may be considered for at-risk patients on an individual basis, as up to 13% of patients CLINICAL STATEMENTS AND GUIDELINES with a surgical aortic valve develop hemodynamic valve dysfunction at a median of 6.7 to 9.9 years Patients typically remain asymptomatic until valve dysfunction is severe enough to result in adverse hemodynamic conse- quences or AF. Depending on the valve type and mechanism of regurgitation, some patients with asymptomatic, significant prosthetic valve regur- gitation may require reintervention. For example, if prosthetic regurgitation is attributable to a bio- prosthetic leaflet tear, more severe acute regur- gitation may occur suddenly and cause clinical decompensation. With prosthetic valve stenosis, TTE diagnosis while the patient is asymptomatic alerts the clinician to the need for more frequent follow-up. 