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Assessment After Surgery or Interventional Procedures on the Aortic Valve

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Textbook of Three-Dimensional Echocardiography

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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.

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Author information

Authors and Affiliations

  1. Department of Cardiology/Structural Heart and Valve Center, Columbia University Medical Center, New York, NY, USA

    Rebecca T. Hahn

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  1. Rebecca T. Hahn
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Correspondence to Rebecca T. Hahn .

Editor information

Editors and Affiliations

  1. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Luigi P. Badano

  2. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Roberto M. Lang

  3. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Denisa Muraru

Electronic Supplementary Material

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)

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)

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)

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)

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

(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)

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

(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)

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)

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)

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

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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Hahn, R.T. (2019). Assessment After Surgery or Interventional Procedures on the Aortic Valve. In: Badano, L., Lang, R., Muraru, D. (eds) Textbook of Three-Dimensional Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-14032-8_15

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  • DOI: https://doi.org/10.1007/978-3-030-14032-8_15

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