Challenging Cases of Aortic Prosthesis Dysfunction, the Importance of Multimodality Imaging, a Case Series

ECG-gated multidetector computed tomography (MDCT) is a promising complementary technique for evaluation of cardiac native and prosthetic structures. MDCT is able to provide a broader coverage with faster scan acquisition times that yield higher spatial and temporal resolution for cardiac structures whose quality may be affected by artifacts on ultrasound. We report a case series about the most challenging complications occurring after prosthetic aortic valve implantation in four patients: pannus, paravalvular leak, prosthesis’ misfolding and subaortic membrane reformation. In all the cases, enhanced MDCT using a retrospective protocol provided accurate 3D morphoanatomic information about cardiac and extracardiac structures, improving and speeding up the correct diagnosis and treatment planning. Integrated imaging, in particular with MDCT, is now the present, and it will increasingly be the future in the assessment of cardiac structural pathology.

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Pre-interventional assessment and calcification score of the aortic valve and annulus, with multi-detector CT, in transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve

South African Journal of Radiology ◽

10.4102/sajr.v19i1.762 ◽

2015 ◽

Vol 19 (1) ◽

Author(s):

Antoinette Reinders ◽

Coert S. De Vries ◽

G. Joubert

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Scoring System ◽

Multimodality Imaging ◽

Final Analysis ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Background: Transcatheter aortic valve implantation (TAVI) provides an acceptable alternative for aortic valve replacement in the elderly, but needs accurate pre-procedural imaging to optimise intervention. Objectives: To evaluate an alternative manual aortic valve calcification scoring system with computed tomography, for patients undergoing TAVI. We hypothesise a correlation between the Free State aortic valve calcium computed tomography score (FACTS) scoring system, valve plaque density and procedure-related complications. Methods: Twenty patients suitable for TAVI were selected according to standard international guidelines and received multimodality imaging prior to intervention. Images were reviewed by two reviewers who were blinded to each other’s scores. Where large inter-individual score variations existed, retraining was done and scores repeated, using a double-blinded method. Matched scores were included in the final analysis. Rosenhek calcification scores were used as a standard of reference. Results: The study comprised 9 (45%) men and 11 (55%) women, with a median age of 83.5 years. Median EuroSCORE was 15.5. FACTS scores ≥6 were associated with the presence of a paravalvular leak (p = 0.01). Procedure-related complications (left bundle branch block, repositioning of the valve and anaemia) were seen in patients with plaques measuring ≥1000 HU (p = 0.07). Conclusion: The FACTS score and averaged valve plaque HU showed potential for predicting a paravalvular leak and procedure-related complications, and could be valuable in the future for optimising patient selection for TAVI.

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The ACURATE neo2 valve system for transcatheter aortic valve implantation: 30-day and 1-year outcomes

Clinical Research in Cardiology ◽

10.1007/s00392-021-01882-3 ◽

2021 ◽

Author(s):

Helge Möllmann ◽

David M. Holzhey ◽

Michael Hilker ◽

Stefan Toggweiler ◽

Ulrich Schäfer ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Pacemaker Implantation ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Valve Thrombosis ◽

Aortic Valve Implantation ◽

And Performance ◽

Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has become standard treatment for elderly patients with symptomatic severe aortic valve stenosis. The ACURATE neo AS study evaluates 30-day and 1-year clinical and hemodynamic outcomes in patients treated with the ACURATE neo2 valve. Methods The primary endpoint of this single-arm multicenter study is 30-day all-cause mortality. Other key endpoints include device performance, echocardiographic measures assessed by an independent core laboratory, and VARC-2 clinical efficacy and safety endpoints through 12 months. Results The study enrolled 120 patients (mean age 82.1 ± 4.0 years; 67.5% female, mean baseline STS score 4.8 ± 3.8%). The VARC-2 composite safety endpoint at 30 days occurred in 13.3% of patients. All-cause mortality was 3.3% at 30 days and 11.9% at 1 year. The 30-day stroke rate was 2.5% (disabling stroke 1.7%); there were no new strokes between 30 days and 12 months. The rate of permanent pacemaker implantation was 15.0% (18/120) at 30 days and 17.8% (21/120) at 1 year. No patients required re-intervention for valve-related dysfunction and there were no cases of valve thrombosis or endocarditis. Patients demonstrated significant improvement in mean aortic valve gradient (baseline 38.9 ± 13.1 mmHg, 1 year 7.8 ± 3.5 mmHg; P < 0.001 in a paired analysis). In the overall population, paravalvular leak was evaluated at 1 year as none/trace in 60.5%, mild in 37.0%, and moderate in 2.5%; no patients had severe PVL. Conclusions One-year outcomes from the ACURATE neo AS study support the safety and performance of TAVI with the ACURATE neo2 valve. Graphic Abstract

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Initial Experiences of Young Cardiologists with Balloon-Expandable Transcatheter Aortic Valve Implantation in Turkey: A Case Series of Eleven Patients

Eurasian Journal of Medicine ◽

10.5152/eajm.2013.21 ◽

2013 ◽

Vol 45 (2) ◽

pp. 99-107 ◽

Cited By ~ 1

Author(s):

Tayyar Gokdeniz ◽

Ahmet Cagri Aykan ◽

Mustafa Tarik Agac ◽

Ali Ihsan Parlar ◽

Orhan Veli Dogan ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Case Series ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Multimodality imaging throughout transcatheter aortic valve implantation

Future Cardiology ◽

10.2217/fca.12.19 ◽

2012 ◽

Vol 8 (3) ◽

pp. 413-424 ◽

Cited By ~ 4

Author(s):

Linda M de Heer ◽

Jolanda Kluin ◽

Pieter R Stella ◽

Gertjan TJ Sieswerda ◽

Willem P Th M Mali ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Multimodality Imaging ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Transcatheter aortic valve implantation

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0023 ◽

2021 ◽

pp. 315-336

Author(s):

Arnold C.T. Ng ◽

Victoria Delgado ◽

Jeroen J. Bax

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Transthoracic Echocardiography ◽

Multimodality Imaging ◽

Imaging Modality ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an established therapy for patients with symptomatic severe aortic stenosis and contraindications for surgical aortic valve replacement or with intermediate and high operative risk in whom the heart team considers that TAVI is the best therapeutic option. Accurate patient selection strongly relates on multimodality imaging consisting mostly of the combination of transthoracic echocardiography and computed tomography. To guide the procedure, fluoroscopy is the mainstay imaging modality. In the follow-up of the patients, transthoracic echocardiography and computed tomography are again the main imaging modalities to use. Cardiovascular magnetic resonance and nuclear imaging have a minimal role in this area.

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Percutaneous Valvular Closure Followed by TAV-in-TAV Intervention during a Single Procedure in order to Treat a Severe Paravalvular Leak after Performing TAVI in a Bicuspid Aortic Stenosis

Case Reports in Cardiology ◽

10.1155/2019/4825607 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Georgios Tzimas ◽

Eric Eeckhout ◽

Panagiotis Antiochos ◽

Christan Roguelov ◽

Stephane Fournier ◽

...

Keyword(s):

Aortic Stenosis ◽

Paravalvular Leak ◽

Haemodynamic Instability ◽

Single Procedure ◽

Transcatheter Aortic Valve ◽

First Case ◽

Effective Reduction ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

In an era where transcatheter aortic valve implantation (TAVI) indications and utilization are expanding beyond high-risk patients, paravalvular leak remains the intervention’s Achilles heel. Effective reduction of paravalvular leak is important in order to ensure an optimal clinical outcome. We present here the first case report in which percutaneous valvular closure using Amplatzer plugs followed by a TAV-in-TAV intervention during the same procedure managed to resolve a severe paravalvular leak with haemodynamic instability, after TAVI for a bicuspid aortic stenosis.

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