Functional Anatomy of Aortic Regurgitation. Role of Transesophageal Echocardiography in Aortic Valve-Sparing Surgery

2010 ◽  
Vol 63 (5) ◽  
pp. 536-543 ◽  
Author(s):  
Pastora Gallego García de Vinuesa ◽  
Antonio Castro ◽  
José Miguel Barquero ◽  
Omar Araji ◽  
Gerardo Brunstein ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Functional Anatomy ◽  
Valve Sparing

Abstract 12320: Assessment of Post-Procedural Aortic Regurgitation After Transcatheter Aortic Valve Replacement During the Procedure: An Intraprocedural Transesophageal Echocardiography Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hirotsugu Mihara ◽  
Kentaro Shibayama ◽  
Hasan Jilaihawi ◽  
Yuji Itabashi ◽  
Javier Berdejo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Color Doppler ◽  
Descending Aorta ◽  
Transcatheter Aortic Valve ◽  
Pulsed Wave Doppler

Introduction: The assessment of post-procedual aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) has not been validated. The purpose of this study was (1) to investigate the value of holodiastolic flow reversal (HDFR) in the descending aorta in patients with PAR after TAVR and (2) to determine which color Doppler parameters are useful for PAR grading using the intraprocedural transesophageal echocardiography (iTEE). Hypothesis: We hypothesized that HDFR in the descending aorta and any color Doppler parameters can delineate significant PAR after TAVR. Methods: Three hundred-eighty patients with severe aortic stenosis underwent TAVR with the Edwards SAPIEN valve with 131 pulsed-wave Doppler tracings from the descending aorta had assessed by iTEE. PAR was evaluated using 2D color Doppler by the cross-sectional area of the vena contracta (VCA) at the aortic annular plane, and by the longitudinal jet extent (mosaic signals, Figure A) compared to the location of the tip of the anterior mitral leaflet (AML). Significant PAR was defined as VCA of ≥10 mm2, corresponding to greater than a moderate grade. Results: In patients with any grade of PAR, pulsed-wave Doppler tracing from the descending aorta, jet extent and VCA were obtained in 100%, 80%, and 74%, respectively. All patients with consistent HDFR had significant PAR. By multivariate analysis, a consistent HDFR and jet extent beyond the tip of AML were independent predictors of significant PAR. A consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificity of 100% and 97%, respectively. In the other hand, patients with both negative HDFR and jet extent of less than halfway to the tip of AML had no significant PAR with a 97% specificity. Conclusions: The presence of HDFR with each cardiac cycle and jet extent beyond the tip of AML are indicative of significant PAR.

Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography

Cardiology ◽  
2016 ◽  
Vol 137 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Alexandra Goncalves ◽  
Charles Nyman ◽  
David R. Okada ◽  
Avinainder Singh ◽  
Jeffrey Swanson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Overall Mortality

Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.

scholarly journals P1088Match and mismatch between opening area and resistance in mild and moderate rheumatic mitral stenosisP1089When should cardiovascular magnetic resonance imaging be considered in patients with chronic aortic or mitral regurgitation?P1090Echocardiographic characteristics of aortic valve fenestration with aortic regurgitation for aortic valve repairP1091Aortic regurgitation assessment by 3D transesophageal echocardiography vena contracta area: usefulness and comparison with 2D methods.P1092Characterising cardiomyopathy in mitral regurgitation due to barlow disease: role of CMRP1093Compensatory peripheral increase in artero-venous o2 difference to severe functional mitral regurgitation in heart failureP1094Prognostic impact of concomitant atrioventricular valve regurgitation in patients undergoing transcatheter aortic valve implantationP1095Morphological characterization of vegetations by real-time three-dimensional transesophageal echocardiography in infective endocarditis: prognostic impactP1096Relation between causative pathogen and echocardiographic findings in patients with infective endocarditis: is there an association and is it clinically relevant?P1097Aortic and mitral valve infective endocarditis: different clinical and echocardiographic features and peculiar complication ratesP1098Vegetation size relevance and impact on prognosis in patients with infective endocarditisP1099Causes of death on the valvular heart disease surveillance list- a 5 year auditP1100Left ventricular non-compaction and idiopathic dilated cardiomyopathy: the significant diagnostic value of longitudinal strainP1101The role of echocardiography in the management of diuretics withdrawal in patients with chronic heart failure and severely reduced ejection fraction: a prospective cohort studyP1102Outcomes in paediatric new onset left ventricle dysfunction and dilatation: differences between post-myocarditis and DCMP1103De novo mitral regurgitation as a cause of heart failure exacerbation in hypertrophic cardiomyopathyP1104Correlation of conventional and new echocardiograhic parameters with sudden cardiac death risk score in patients with hypertrophic cardiomyopathyP1105Inverse correlation between myocardial fibrosis and left ventricular function in rheumatic mitral stenosis: a preliminary study with cardiac magnetic resonanceP1106Left ventricular diastolic dysfunction and cardiac sympathetic derangement in patients with Anderson-Fabry disease: a 2D speckle tracking echocardiography and cardiac 123I-MIBG studyP1107Left ventricular hypertrophy and mild cognitive impairment as markers for target organ damage in hypertensive patients with multiple risk factorsP1108Subclinical left ventricular dysfunction in asymptomatic type 1 diabetic childrenP1109Minimal differences shown by echocardiography and NT-proBNP level distinguishing cardiotoxic effect related to breast cancer therapy in patients with or without HER2 expression.P1110Speed of recovery of left ventricular function is not related to the prognosis of takotsubo cardiomyopathy - a portuguese multicenter studyP1111Myocardial dysfunction in Takotsubo cardiomyopathy - more than meets the eye?P1112Obstructive sleep apnea and echocardiographic parameters

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii227-ii234
Author(s):  
I. El-Dosouky ◽  
CL. Polte ◽  
T. Okubo ◽  
A. Gonzalez Gomez ◽  
B. Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Transesophageal Echocardiography ◽  
Ventricular Function ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular

scholarly journals Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation?☆

2010 ◽  
Vol 38 (5) ◽  
pp. 515-522 ◽  
Author(s):  
Catalin Constantin Badiu ◽  
Walter Eichinger ◽  
Sabine Bleiziffer ◽  
Grit Hermes ◽  
Ina Hettich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Severe Aortic Regurgitation ◽  
Valve Sparing
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