Echocardiographic Imaging for Transcatheter Aortic Valve Replacement

  • Wanda DesteEmail author
  • Denise Todaro
  • Gerlando Pilato


Echocardiography plays an important role in the percutaneous procedure of transcatheter aortic valve replacement (TAVR), starting with pre-implant screening, choosing the correct size of the valve device, in the case of complications during implantation, and in post-implant and follow-up assessment.


  1. 1.
    Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1–23, quiz 101–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMedGoogle Scholar
  3. 3.
    Barbanti M, Yang TH, Rodès Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation. 2013;128:244–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Barbanti M, Webb JG, Gilard M, Capodanno D, Tamburino C. Transcatheter aortic valve implantation in 2017: state of the art. EuroIntervention. 2017;13:AA11–21.Google Scholar
  6. 6.
    Detaint D, Lepage L, Himbert D, et al. Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence. J Am Coll Cardiol Intv. 2009;2:821–7.CrossRefGoogle Scholar
  7. 7.
    Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for trans-catheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1:74–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Tzikas A, Schultz CJ, Piazza N, et al. Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2011;77:868–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Koos R, Altiok E, Mahnken AH, et al. Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for trans-catheter aortic valve implantation. Int J Cardiol. 2012;158:353–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Altiok E, Koos R, Schroder J, et al. Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation. Heart. 2011;97:1578–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Hamdan A, Guetta V, Konen E, et al. Deformation dynamics and mechanical properties of the aortic annulus by four-dimensional computed tomography insights into the functional anatomy of the aortic valve complex and implications for transcatheter aortic valve therapy. J Am Coll Cardiol. 2012;59:119–27.CrossRefPubMedGoogle Scholar
  12. 12.
    Hahn RT, Khalique O, Williams MR, et al. Predicting paravalvular regurgitation following transcatheter valve replacement: utility of a novel method for three-dimensional echocardiographic measurements of the aortic annulus. J Am Soc Echocardiogr. 2013;26:1043–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Santos N, de Agustin JA, Almeria C, et al. Prosthesis/annulus discongruence assessed by three-dimensional transesophageal echocardiography: a predictor of significant paravalvular aortic regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging. 2012;13:931–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Janosi RA, Kahlert P, Plicht B, et al. Measurement of the aortic annulus size by real-time three-dimensional transesophageal echocardiography. Minim Invasive Ther Allied Technol. 2011;20:85–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Tsang W, Bateman MG, Weinert L, et al. Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart. 2012;98:1146–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Gripari P, Ewe SH, Fusini L, et al. Intra-operative 2D and 3D transesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation. Heart. 2012;98:1229–36.CrossRefPubMedGoogle Scholar
  17. 17.
    Smith LA, Dworakowski R, Bhan A, et al. Real-time three-dimensional transesophageal echocardiography adds value to transcatheter aortic valve implantation. J Am Soc Echocardiogr. 2013;26:359–69.CrossRefPubMedGoogle Scholar
  18. 18.
    Jilaihawi H, Doctor N, Kashif M, et al. Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography. J Am Coll Cardiol. 2013;61:908–16.CrossRefPubMedGoogle Scholar
  19. 19.
    Khalique OK, Kodali SK, Paradis JM, et al. Aortic annular sizing using a novel three-dimensional echocardiographic method: use and comparison with cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7:155–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Kasel AM, Cassese S, Bleiziffer S, et al. Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. J Am Coll Cardiol Img. 2013;6:249–62.CrossRefGoogle Scholar
  21. 21.
    Burgstahler C, Kunze M, Loffler C, Gawaz MP, Hombach V, Merkle N. Assessment of left ventricular outflow tract geometry in non-stenotic and stenotic aortic valves by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2006;8:825–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Doddamani S, Bello R, Friedman MA, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography. 2007;24:860–6.CrossRefPubMedGoogle Scholar
  23. 23.
    De Vecchi C, Caudron J, Dubourg B, et al. Effect of the ellipsoid shape of the left ventricular outflow tract on the echocardiographic assessment of aortic valve area in aortic stenosis. J Cardiovasc Comput Tomogr. 2014;8:52–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Montealegre-Gallegos M, Owais K, Hess P, Jainandunsing JS, Matyal R. Cardiac output calculation and three-dimensional echocardiography. J Cardiothorac Vasc Anesth. 2014;28:547–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Saitoh T, Shiota M, Izumo M, et al. Comparison of left ventricular outflow geometry and aortic valve area in patients with aortic stenosis by two-dimensional versus three-dimensional echocardiography. Am J Cardiol. 2012;109:1626–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Gaspar T, Adawi S, Sachner R, et al. Three-dimensional imaging of the left ventricular outflow tract: impact on aortic valve area estimation by the continuity equation. J Am Soc Echocardiogr. 2012;25:749–57.CrossRefPubMedGoogle Scholar
  27. 27.
    Malouf J, Le Tourneau T, Pellikka P, et al. Aortic valve stenosis in community medical practice: determinants of outcome and implications for aortic valve replacement. J Thorac Cardiovasc Surg. 2012;144:1421–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Nishimura RA, Otto C. 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation. Heart. 2014;100:905–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Masson JB, Kovac J, Schuler G, et al. Trans-catheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. J Am Coll Cardiol Intv. 2009;2:811–20.CrossRefGoogle Scholar
  30. 30.
    Ewe SH, Ng AC, Schuijf JD, et al. Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation. Am J Cardiol. 2011;108:1470–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Khalique OK, Hahn RT, Gada H, et al. Quantity and location of aortic valve complex calcification predicts severity and location of paravalvular regurgitation and frequency of post-dilation after balloon-expandable transcatheter aortic valve replacement. J Am Coll Cardiol Intv. 2014;7:885–94.CrossRefGoogle Scholar
  32. 32.
    Dvir D, Lavi I, Eltchaninoff H, et al. Multicenter evaluation of Edwards SAPIEN positioning during transcatheter aortic valve implantation with correlates for device movement during final deployment. J Am Coll Cardiol Intv. 2012;5:563–70.CrossRefGoogle Scholar
  33. 33.
    Haensig M, Lehmkuhl L, Rastan AJ, et al. Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical aortic valve implantation. Eur J Cardiothorac Surg. 2012;41:1234–40; discussion 1240–1.CrossRefPubMedGoogle Scholar
  34. 34.
    Feuchtner G, Plank F, Bartel T, et al. Prediction of paravalvular regurgitation after transcatheter aortic valve implantation by computed tomography: value of aortic valve and annular calcification. Ann Thorac Surg. 2013;96:1574–80.CrossRefPubMedGoogle Scholar
  35. 35.
    Colli A, D’Amico R, Kempfert J, Borger MA, Mohr FW, Walther T. Transesophageal echocardiographic scoring for transcatheter aortic valve implantation: impact of aortic cusp calcification on postoperative aortic regurgitation. J Thorac Cardiovasc Surg. 2011;142:1229–35.CrossRefPubMedGoogle Scholar
  36. 36.
    Genereux P, Reiss GR, Kodali SK, Williams MR, Hahn RT. Periaortic hematoma after transcatheter aortic valve replacement: description of a new complication. Catheter Cardiovasc Interv. 2012;79:766–76.CrossRefPubMedGoogle Scholar
  37. 37.
    Leber AW, Kasel M, Ischinger T, et al. Aortic valve calcium score as a predictor for outcome after TAVI using the CoreValve revalving system. Int J Cardiol. 2013;166:652–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Kochman J, Huczek Z, Scislo P, et al. Comparison of 1- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol. 2014;114:757–62.CrossRefPubMedGoogle Scholar
  39. 39.
    Wijesinghe N, Ye J, Rodés-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. J Am Coll Cardiol Intv. 2010;3:1122–5.CrossRefGoogle Scholar
  40. 40.
    Ferrari E, Locca D, Sulzer C, et al. Successful transapical aortic valve implantation in a congenital bicuspid aortic valve. Ann Thorac Surg. 2010;90:630–2.CrossRefPubMedGoogle Scholar
  41. 41.
    Chiam PT, Chao VT, Tan SY, et al. Percutaneous transcatheter heart valve implantation in a bicuspid aortic valve. J Am Coll Cardiol Intv. 2010;3:559–61.CrossRefGoogle Scholar
  42. 42.
    Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.CrossRefPubMedGoogle Scholar
  43. 43.
    Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg. 2007;133:1226–33.CrossRefPubMedGoogle Scholar
  44. 44.
    Mylotte D, Lefevre T, Sondergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol. 2014;64:2330–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Barbanti M, Leipsic J, Binder R, et al. Underexpansion and ad hoc post-dilation in selected patients undergoing balloon-expandable transcatheter aortic valve replacement. J Am Coll Cardiol. 2014;63:976–81.Google Scholar
  46. 46.
    Leipsic J, Gurvitch R, Labounty TM, et al. Multidetector computed tomography in transcatheter aortic valve implantation. J Am Coll Cardiol Img. 2011;4:416–29.CrossRefGoogle Scholar
  47. 47.
    Zoghbi WA, Chambers JB, Dumesnil JG, 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;22:975–1014; 1082–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Clavel MA, Webb JG, Pibarot P, et al. Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis. J Am Coll Cardiol. 2009;53:1883–91.CrossRefPubMedGoogle Scholar
  49. 49.
    Ben Zekry S, Saad RM, Ozkan M, et al. Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. JACC Cardiovasc Imaging. 2011;4:1161–70.CrossRefPubMedGoogle Scholar
  50. 50.
    Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95.CrossRefPubMedGoogle Scholar
  51. 51.
    Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011;24:937–65.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of CardiologyFerrarotto Hospital, University of CataniaCataniaItaly

Personalised recommendations