EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease

Abstract

The introduction of devices for transcatheter aortic valve implantation, mitral repair, and closure of prosthetic paravalvular leaks has led to a greatly expanded armamentarium of catheter-based approaches to patients with regurgitant as well as stenotic valvular disease. Echocardiography plays an essential role in identifying patients suitable for these interventions and in providing intra-procedural monitoring. Moreover, echocardiography is the primary modality for post-procedure follow-up. The echocardiographic assessment of patients undergoing transcatheter interventions places demands on echocardiographers that differ from those of the routine evaluation of patients with native or prosthetic valvular disease. Consequently, the European Association of Echocardiography in partnership with the American Society of Echocardiography has developed the recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. It is intended that this document will serve as a reference for echocardiographers participating in any or all stages of new transcatheter treatments for patients with valvular heart disease.

Paravalvular Aortic Leak After Transcatheter Aortic Valve Replacement

“…Most commonly, PVL is assessed qualitatively by estimating the proportion of the circumference of the sewing ring occupied by the jet: <10% of the sewing ring suggests mild, 10% to 20% suggests moderate, and >20% suggests severe. 49 Overall aortic regurgitation is classified as absent (0), trace (<I), mild (I), moderate (II), and severe (III or IV).…”

Diagnosis and Treatment of Left-Sided Prosthetic Paravalvular Regurgitation

“…Color flow imaging is used to localize the regurgitant jet and to assess its severity (table 1). Apart from the usual assessment criteria of jet width and jet area, the presence of a large proximal isovelocity surface area (PISA), albeit not validated for paravalvural MR jets, is helpful in quantifying the regurgitation [13]. The PISA method can also be of help in quantifying paravalvular MR when TTE is the only imaging modality available [14].…”

“…It should also be noted that even small hemodynamically insignificant residual leaks might cause significant hemolysis. The use of multiple smaller devices, albeit technically challenging, might be preferable to one large device and some advocate the insertion of a device at the time of surgical implantation, especially when exuberant annular calcification limits suturing [9,13]. …”

Mitralklappenstruktur und -funktion

“…Mischformen mit Beteiligung sowohl der Klappenstruktur als auch von Ventrikelfunktion und -geometrie sind häufig [19]. Für die Einteilung des Schweregrades der Mitralinsuffizienz und für die pathogenetische Differenzierung in DMR und FMR spielen die 2-D-und die 3-D-Echokardiographie bei der Selektion der Patienten für unterschiedliche Verfahren und für die Durchführung von Interventionen eine unerlässliche Rolle [20,21,22].…”