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Assessment After Surgery or Interventional Procedures on the Aortic Valve

  • Rebecca T. HahnEmail author
Chapter

Abstract

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.

Keywords

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)

References

  1. 1.
    Oxenham H, Bloomfield P, Wheatley DJ, Lee RJ, Cunningham J, Prescott RJ, et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart. 2003;89(7):715–21.CrossRefGoogle Scholar
  2. 2.
    Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the veterans affairs randomized trial. J Am Coll Cardiol. 2000;36(4):1152–8.CrossRefGoogle Scholar
  3. 3.
    Stassano P, Di Tommaso L, Monaco M, Iorio F, Pepino P, Spampinato N, et al. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol. 2009;54(20):1862–8.CrossRefGoogle Scholar
  4. 4.
    D’Onofrio A, Messina A, Lorusso R, Alfieri OR, Fusari M, Rubino P, et al. Sutureless aortic valve replacement as an alternative treatment for patients belonging to the “gray zone” between transcatheter aortic valve implantation and conventional surgery: a propensity-matched, multicenter analysis. J Thorac Cardiovasc Surg. 2012;144(5):1010–6.CrossRefGoogle Scholar
  5. 5.
    Flameng W, Herregods MC, Hermans H, Van der Mieren G, Vercalsteren M, Poortmans G, et al. Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes. J Thorac Cardiovasc Surg. 2011;142(6):1453–7.CrossRefGoogle Scholar
  6. 6.
    Martens S, Sadowski J, Eckstein FS, Bartus K, Kapelak B, Sievers HH, et al. Clinical experience with the ATS 3f enable(R) sutureless bioprosthesis. Eur J Thorac Cardiovasc Surg. 2011;40(3):749–55.Google Scholar
  7. 7.
    Phan K, Tsai YC, Niranjan N, Bouchard D, Carrel TP, Dapunt OE, et al. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2015;4(2):100–11.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Gilmanov D, Farneti PA, Miceli A, Bevilacqua S, Glauber M. Perceval S sutureless aortic valve prosthesis implantation via a right anterior minithoracotomy. Multimed Man Cardiothorac Surg [Video-Audio Media]. 2013;2013:mmt012.Google Scholar
  9. 9.
    Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol. 2000;36(4):1131–41.CrossRefGoogle Scholar
  10. 10.
    Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK. Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr [Consensus Development Conference]. 2012;6(6):366–80.CrossRefGoogle Scholar
  11. 11.
    Leipsic J, Gurvitch R, LaBounty TM, Min JK, Wood D, Johnson M, et al. Multidetector computed tomography in transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2011;4(4):416–29.CrossRefGoogle Scholar
  12. 12.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.CrossRefGoogle Scholar
  13. 13.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1–23; quiz 101–2.CrossRefGoogle Scholar
  14. 14.
    Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22(9):975–1014; quiz 82–4.CrossRefGoogle Scholar
  15. 15.
    Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006;92(8):1022–9.CrossRefGoogle Scholar
  16. 16.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119(7):1034–48.CrossRefGoogle Scholar
  17. 17.
    Gadhinglajkar S, Namboodiri N, Pillai V, Sreedhar R. Double-envelope continuous-wave Doppler flow profile across a tilting-disc mitral prosthesis: intraoperative significance. J Cardiothorac Vasc Anesth. 2011;25(3):491–4.CrossRefGoogle Scholar
  18. 18.
    Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg. 2008;135(4):732–8.CrossRefGoogle Scholar
  19. 19.
    Effron MK, Popp RL. Two-dimensional echocardiographic assessment of bioprosthetic valve dysfunction and infective endocarditis. J Am Coll Cardiol. 1983;2(4):597–606.CrossRefGoogle Scholar
  20. 20.
    Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137–42.CrossRefGoogle Scholar
  21. 21.
    Tong AT, Roudaut R, Ozkan M, Sagie A, Shahid MS, Pontes Junior SC, et al. Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry. J Am Coll Cardiol. 2004;43(1):77–84.CrossRefGoogle Scholar
  22. 22.
    Lin SS, Tiong IY, Asher CR, Murphy MT, Thomas JD, Griffin BP. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography. Am J Cardiol. 2000;86(10):1097–101.CrossRefGoogle Scholar
  23. 23.
    Sudhakar S, Sewani A, Agrawal M, Uretsky BF. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): a comprehensive review. J Am Soc Echocardiogr. 2010;23(10):1009–18; quiz 112.CrossRefGoogle Scholar
  24. 24.
    Taramasso M, Maisano F, Latib A, Denti P, Guidotti A, Sticchi A, et al. Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience. Eur Heart J Cardiovasc Imaging. 2014;15(10):1161–7.CrossRefGoogle Scholar
  25. 25.
    Garcia MJ, Vandervoort P, Stewart WJ, Lytle BW, Cosgrove DM 3rd, Thomas JD, et al. Mechanisms of hemolysis with mitral prosthetic regurgitation. Study using transesophageal echocardiography and fluid dynamic simulation. J Am Coll Cardiol. 1996;27(2):399–406.CrossRefGoogle Scholar
  26. 26.
    Echevarria JR, Bernal JM, Rabasa JM, Morales D, Revilla Y, Revuelta JM. Reoperation for bioprosthetic valve dysfunction. A decade of clinical experience. Eur J Cardiothorac Surg. 1991;5(10):523–6; discussion 7.CrossRefGoogle Scholar
  27. 27.
    Hourihan M, Perry SB, Mandell VS, Keane JF, Rome JJ, Bittl JA, et al. Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol. 1992;20(6):1371–7.CrossRefGoogle Scholar
  28. 28.
    Moore JD, Lashus AG, Prieto LR, Drummond-Webb J, Latson LA. Transcatheter coil occlusion of perivalvular mitral leaks associated with severe hemolysis. Catheter Cardiovasc Interv [Case Reports]. 2000;49(1):64–7.CrossRefGoogle Scholar
  29. 29.
    Eisenhauer AC, Piemonte TC, Watson PS. Closure of prosthetic paravalvular mitral regurgitation with the Gianturco-Grifka vascular occlusion device. Catheter Cardiovasc Interv [Case Reports]. 2001;54(2):234–8.CrossRefGoogle Scholar
  30. 30.
    Webb JG, Pate GE, Munt BI. Percutaneous closure of an aortic prosthetic paravalvular leak with an Amplatzer duct occluder. Catheter Cardiovasc Interv. 2005;65(1):69–72.CrossRefGoogle Scholar
  31. 31.
    Nietlispach F, Johnson M, Moss RR, Wijesinghe N, Gurvitch R, Tay EL, et al. Transcatheter closure of paravalvular defects using a purpose-specific occluder. JACC Cardiovasc Interv. 2010;3(7):759–65.CrossRefGoogle Scholar
  32. 32.
    Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv. 2011;4(4):314–21.CrossRefGoogle Scholar
  33. 33.
    Ruiz CE, Jelnin V, Kronzon I, Dudiy Y, Del Valle-Fernandez R, Einhorn BN, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol [Comparative Study]. 2011;58(21):2210–7.CrossRefGoogle Scholar
  34. 34.
    Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011;58(21):2218–24.CrossRefGoogle Scholar
  35. 35.
    Moscucci M, Deeb GM, Bach D, Eagle KA, Williams DM. Coil embolization of a periprosthetic mitral valve leak associated with severe hemolytic anemia. Circulation [Case Reports]. 2001;104(16):E85–6.Google Scholar
  36. 36.
    Hein R, Wunderlich N, Robertson G, Wilson N, Sievert H. Catheter closure of paravalvular leak. EuroIntervention. 2006;2(3):318–25.PubMedGoogle Scholar
  37. 37.
    Rihal CS, Sorajja P, Booker JD, Hagler DJ, Cabalka AK. Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv. 2012;5(2):121–30.CrossRefGoogle Scholar
  38. 38.
    Bogunovic N, Faber L, Scholtz W, Mellwig KP, Horstkotte D, van Buuren F. Real-time three-dimensional transoesophageal echocardiography during percutaneous transcatheter occlusion of mitral periprosthetic paravalvular leak. Eur J Echocardiogr. 2011;12(3):E27.PubMedGoogle Scholar
  39. 39.
    Hoffmann R, Kaestner W, Altiok E. Closure of a paravalvular leak with real-time three-dimensional transesophageal echocardiography for accurate sizing and guiding. J Invasive Cardiol. 2013;25(11):E210–1.PubMedGoogle Scholar
  40. 40.
    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.CrossRefGoogle Scholar
  41. 41.
    Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98.CrossRefGoogle Scholar
  42. 42.
    Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014;63(19):1972–81.CrossRefGoogle Scholar
  43. 43.
    Adams DH, Popma JJ, Reardon MJ. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;371(10):967–8.CrossRefGoogle Scholar
  44. 44.
    Oguri A, Yamamoto M, Mouillet G, Gilard M, Laskar M, Eltchaninoff H, et al. Clinical outcomes and safety of transfemoral aortic valve implantation under general versus local anesthesia: subanalysis of the French Aortic National CoreValve and Edwards 2 registry. Circ Cardiovasc Interv. 2014;7(4):602–10.CrossRefGoogle Scholar
  45. 45.
    Bagur R, Rodes-Cabau J, Doyle D, De Larochelliere R, Villeneuve J, Lemieux J, et al. Usefulness of TEE as the primary imaging technique to guide transcatheter transapical aortic valve implantation. JACC Cardiovasc Imaging. 2011;4(2):115–24.CrossRefGoogle Scholar
  46. 46.
    de Brito FS Jr, Carvalho LA, Sarmento-Leite R, Mangione JA, Lemos P, Siciliano A, et al. Outcomes and predictors of mortality after transcatheter aortic valve implantation: Results of the Brazilian registry. Catheter Cardiovasc Interv. 2015;85(5):E153–62.CrossRefGoogle Scholar
  47. 47.
    Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the american society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921–64.CrossRefGoogle Scholar
  48. 48.
    Babaliaros VC, Liff D, Chen EP, Rogers JH, Brown RA, Thourani VH, et al. Can balloon aortic valvuloplasty help determine appropriate transcatheter aortic valve size? JACC Cardiovasc Interv. 2008;1(5):580–6.CrossRefGoogle Scholar
  49. 49.
    Kasel AM, Cassese S, Bleiziffer S, Amaki M, Hahn RT, Kastrati A, et al. Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. JACC Cardiovasc Imaging. 2013;6(2):249–62.CrossRefGoogle Scholar
  50. 50.
    Patsalis PC, Al-Rashid F, Neumann T, Plicht B, Hildebrandt HA, Wendt D, et al. Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation for improved valve sizing. JACC Cardiovasc Interv. 2013;6(9):965–71.CrossRefGoogle Scholar
  51. 51.
    Ben-Dor I, Pichard AD, Satler LF, Goldstein SA, Syed AI, Gaglia MA Jr, et al. Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv. 2010;3(11):1150–6.CrossRefGoogle Scholar
  52. 52.
    Dvir D, Lavi I, Eltchaninoff H, Himbert D, Almagor Y, Descoutures F, et al. Multicenter evaluation of Edwards SAPIEN positioning during transcatheter aortic valve implantation with correlates for device movement during final deployment. JACC Cardiovasc Interv. 2012;5(5):563–70.CrossRefGoogle Scholar
  53. 53.
    Athappan G, Patvardhan E, Tuzcu EM, Svensson LG, Lemos PA, Fraccaro C, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literaturemeta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61(15):1585–95.CrossRefGoogle Scholar
  54. 54.
    Hahn RT, Little SH, Monaghan MJ, Kodali SK, Williams M, Leon MB, et al. Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR. JACC Cardiovasc Imaging Dent Rev. 2015;8(3):261–87.CrossRefGoogle Scholar
  55. 55.
    Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgitation following TAVR: a proposal of Unifying Grading Scheme. JACC Cardiovasc Imaging Dent Rev. 2015;8(3):340–60.CrossRefGoogle Scholar
  56. 56.
    Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS, et al. Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Echocardiography. 2005;22(9):775–81.CrossRefGoogle Scholar
  57. 57.
    Pirat B, Little SH, Igo SR, McCulloch M, Nose Y, Hartley CJ, et al. Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation. J Am Soc Echocardiogr. 2009;22(3):306–13.CrossRefGoogle Scholar
  58. 58.
    Poh KK, Levine RA, Solis J, Shen L, Flaherty M, Kang YJ, et al. Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography. Eur Heart J. 2008;29(20):2526–35.CrossRefGoogle Scholar
  59. 59.
    Singh P, Manda J, Hsiung MC, Mehta A, Kesanolla SK, Nanda NC, et al. Live/real time three-dimensional transesophageal echocardiographic evaluation of mitral and aortic valve prosthetic paravalvular regurgitation. Echocardiography. 2009;26(8):980–7.CrossRefGoogle Scholar
  60. 60.
    Singh P, Inamdar V, Hage FG, Kodali V, Karakus G, Suwanjutah T, et al. Usefulness of live/real time three-dimensional transthoracic echocardiography in evaluation of prosthetic valve function. Echocardiography. 2009;26(10):1236–49.CrossRefGoogle Scholar

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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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