Assessment After Surgery or Interventional Procedures on the Aortic Valve

  • Rebecca T. HahnEmail author


This chapter will cover the post-operative assessment of surgical and transcatheter aortic valves. Complications of surgical prostheses including paravalvular regurgitation and the use of three-dimensional imaging for guidance of prosthetic paravalvular regurgitation closure will also be discussed. Finally, the intra-procedural monitoring of transcatheter aortic valve replacement will be reviewed with case examples.


Surgical aortic valve replacement Bioprosthetic Mechanical prosthesis Transcatheter aortic valve replacement 

Supplementary material

Video 15.1

Endocarditis of a bioprosthetic in aortic position showing a mass on the non-coronary sinus leaflet. By positioning the cursor on the mass, it is possible to see it in an orthogonal plane. AO ascending aorta, LA left atrium, RA right atrium (AVI 46365 kb)

Video 15.2a

Transesophageal volume rendering display of a vegetation (red asterisk) attached to the non-coronary sinus leaflet of the aortic bioprosthesis. Transversal cut-plane to visualize the prosthesis en face from the aortic perspective (AVI 56903 kb)

Video 15.2b

Longitudinal cut-plane to appreciate vegetation’s length and point of attachment. Three-dimensional echocardiography allows a better appreciation of the vegetation size (volume vs. linear dimensions) and mobility (no out-of-plane motion). AO ascending aorta, LVOT left ventricular outflow tract (AVI 61117 kb)

Video 15.3

Transthoracic 3DE color data set acquired from the apical approach in a patients with paraprosthetic regurgitation. The data set has been sliced using a cutplane (broken yellow line) oriented perpendicular to the prosthesis stent and passing through the distal part of it in order to obtain an en face view of the valve from the ventricular perspective which allows to assess the circumferential extension of the para-valvular leak (AVI 17988 kb)

Video 15.4a

(Left) Five-chamber two-dimensional echocardiography with color Doppler showing multiple para-valvular leaks (AVI 7046 kb)

Video 15.4b

(Right) Transthoracic volume rendered 3DE color acquisition showing the TAVR prosthesis en face from the ventricular perspective and two para-valvular leaks at 12 o’clock and from 1 to 3 o’clock. AO aorta, LA left atrium, LV left ventricle, RV right ventricle (AVI 5610 kb)

Video 15.5a

(Left) Real-time transesophageal 3DE to monitor guiding wire positioning in the aortic root during TAVR procedure (MPG 1386 kb)

Video 15.5b

(Right) Real-time transesophageal 3DE to monitor guiding wire positioning after crossing the aortic valve during TAVR procedure. LA left atrium, LVOT left ventricular outflow tract, AV aortic valve (AVI 1139 kb)

Video 15.6

Real time volume rendering transesophageal 3DE of balloon valvuloplasty during TAVR procedure. LA left atrium, LVOT left ventricular outflow tract, AV aortic valve (AVI 547 kb)

Video 15.7

Real time volume rendering transesophageal 3DE to check prosthesis position before its release during TAVR procedure. LA left atrium, LVOT left ventricular outflow tract, AV aortic valve (AVI 968 kb)

Video 15.8

Volume rendering transesophageal 3DE of a Sapien 3 prosthesis after it release (AVI 3002 kb)

Video 15.9

Multislice display of a transthoracic 3DE color data set acquired from the apical approach to identify the origin and circumferential extension of multiple para-valvular leaks (AVI 8880 kb)


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Cardiology/Structural Heart and Valve CenterColumbia University Medical CenterNew YorkUSA

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