ECHO 2013 / Evaluating the Post-Transcatheter Valve Patient
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LVOT Diameter and Velocity in
Balloon-Expandable Valves
VTI=21 |
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VTI=32 |
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Clavel et al. JACC Img; 4:1053–62, 2011
Measurement of LVOT Diameter &
Velocity in Self-Expandable Valves
Changes in Valve Hemodynamic
Performance Over Time:
The Canadian Multicenter Experience
Rodés-Cabau J et al.; JACC, 2012;60:1864–75
Structural Valve Deterioration
Post TAVI
74 y.o. man
5 year post TAVI Recurrent dyspnea Pmean: 53 mmHg
Ong et al. Eur Heart J, 2012
Serial Follow-up following TAVI: Case Study
30
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Mean Gradient |
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1.5 |
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0.5 |
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1-Mo 1-Yr 2-Yr 3-Yr |
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1-Mo 1-Yr 2-Yr 3-Yr |
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DVI |
3D TEE |
0.5 0.4 0.3 0.2
0.1 
1-Mo 1-Yr 2-Yr 3-Yr
Key Messages
Paravalvular regurgitation: Multiparametric approach is key: circumferencial extent, quantitative method, 3D color Doppler
Transcatheter valve EOA:
In balloon expandable valves, LVOT diameter and velocity should be measured just underneath the apical margin of the valve stent
In self-expandable valves, where the landing zone of the stent is low in the LVOT, the diameter and velocity may both be measured within the proximal portion of the stent
Follow-up: it may be preferable to use the same LVOT diameter for all serial evaluations and/or to consider DVI
Kappetein et al. Eur Heart J, 2012
Zoghbi et al. J Am Soc Echocardiogr, 22:975-1014, 2009
Pibarot & Dumesnil Heart 2012;
98:69-78, 2012
Zamorano JL; J Am Soc Echocardiogr
2011;24:937-65