EchoCG in TAVI: Assessment of Paravalvular Regurgitation Before and After Implantation
Methodological Basis
The assessment of regurgitation after transcatheter aortic valve implantation (TAVI) is conducted in accordance with ASE recommendations for evaluating valve regurgitation after percutaneous repair or replacement (Zoghbi WA, Asch FM, Bruce C, et al. J Am Soc Echocardiogr 2019;32:431-75). General principles of non-invasive assessment of native valve regurgitation are outlined in a separate ASE document (Zoghbi WA et al. J Am Soc Echocardiogr 2017;30:303-71).
The Role of TEE in Intraoperative Assessment
Intraoperative transesophageal echocardiography is used to assess paravalvular regurgitation (Konoske R, Whitener G, Nicoara A. Anesth Analg 2015;121:329-36). The prognostic significance of even moderate periprosthetic regurgitation detected intraoperatively was noted in a study (O'Rourke DJ et al. J Am Coll Cardiol 2001;38:163-6). The prevalence and clinical significance of incidental paravalvular regurgitation were studied using TEE (Ionescu A, Fraser AC, Butchart EG. Heart 2003;89:1316-21).
Three-Dimensional Echocardiography
Three-dimensional echocardiography is used for the assessment and management of paravalvular regurgitation, allowing for localization and characterization of jets (Kinno M, Raissi SR, Olson KA, et al. Echocardiography 2018;35:2056-70).
Preoperative Assessment and Sizing
The assessment of the aortic annulus by CT and its impact on early residual aortic regurgitation after TAVI were considered in a study (Buzzatti N, Maisano F, Latib A, et al. Eur J Cardiothorac Surg 2013;43:43-50). A new three-dimensional echocardiographic method for measuring the aortic annulus was described in a study (Khalique OK, Kodali SK, Paradis J-M, et al. Circulation 2014;7:155-63). For the assessment of the effective orifice area, using the annular diameter instead of the LVOT diameter improves agreement with invasively measured area (LaBounty TM et al. JACC Cardiovasc Imaging 2014;7:1065-6).
Specific quantitative thresholds for grading paravalvular regurgitation in the available fragments are not provided [clarify].
Frequently asked questions
Which document should be referenced for the assessment of regurgitation after TAVI?
The ASE recommendations for evaluating valve regurgitation after percutaneous repair or replacement (Zoghbi WA, Asch FM, Bruce C, et al. J Am Soc Echocardiogr 2019;32:431-75).
What is the role of 3D echocardiography in paravalvular regurgitation?
3D echocardiography is used for the assessment and management of paravalvular regurgitation, allowing for localization and characterization of jets (Kinno M et al. Echocardiography 2018).
Does moderate periprosthetic regurgitation detected intraoperatively have significance?
Yes, its initial significance was evaluated in the study by O'Rourke DJ et al. (J Am Coll Cardiol 2001;38:163-6). Specific thresholds in the provided fragments are absent [clarify].
Which method is preferred for preoperative prosthesis sizing?
CT assessment of the aortic annulus (Buzzatti N et al. 2013) and the three-dimensional echocardiographic method for measuring the annulus (Khalique OK et al. Circulation 2014) are used.
What improves the agreement between echocardiographic and invasive orifice area?
Using the aortic annulus diameter instead of the LVOT diameter (LaBounty TM et al. JACC Cardiovasc Imaging 2014;7:1065-6).