Value and Limitations of Transesophageal Echocardiography in the Evaluation of Aortic Prostheses

Mohr-Kahaly, Susanne; Kupferwasser, Iri; Erbel, Raimund; Wittlich, N; Iversen, Stein; Oelert, H.; Meyer, Jürgen

doi:10.1016/s0894-7317(14)80251-4

Cited by 36 publications

(8 citation statements)

References 24 publications

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“…Unfortunately, the precise grading of paravalvular AR remains controversial and many echocardiography experts believe that grading schemes for prosthetic central and paravalvular AR should be different. 90,108–111 Recently, in the setting of TAVI, criteria for assessing paravalvular AR severity have emphasized a ‘jet anatomy’ classification, stressing the location, circumferential extent, and width of the AR jet. 90 Haemodynamic factors can also be useful to assess the AR severity immediately after valve implantation (e.g.…”

Section: Prosthetic Valve Performancementioning

confidence: 99%

Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium

Leon

Piazza

Nikolsky

et al. 2011

European Heart Journal

905

635

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ObjectivesTo propose standardized consensus definitions for important clinical endpoints in transcatheter aortic valve implantation (TAVI), investigations in an effort to improve the quality of clinical research and to enable meaningful comparisons between clinical trials. To make these consensus definitions accessible to all stakeholders in TAVI clinical research through a peer reviewed publication, on behalf of the public health.BackgroundTranscatheter aortic valve implantation may provide a worthwhile less invasive treatment in many patients with severe aortic stenosis and since its introduction to the medical community in 2002, there has been an explosive growth in procedures. The integration of TAVI into daily clinical practice should be guided by academic activities, which requires a harmonized and structured process for data collection, interpretation, and reporting during well-conducted clinical trials.Methods and resultsThe Valve Academic Research Consortium established an independent collaboration between Academic Research organizations and specialty societies (cardiology and cardiac surgery) in the USA and Europe. Two meetings, in San Francisco, California (September 2009) and in Amsterdam, the Netherlands (December 2009), including key physician experts, and representatives from the US Food and Drug Administration (FDA) and device manufacturers, were focused on creating consistent endpoint definitions and consensus recommendations for implementation in TAVI clinical research programs. Important considerations in developing endpoint definitions included (i) respect for the historical legacy of surgical valve guidelines; (ii) identification of pathophysiological mechanisms associated with clinical events; (iii) emphasis on clinical relevance. Consensus criteria were developed for the following endpoints: mortality, myocardial infarction, stroke, bleeding, acute kidney injury, vascular complications, and prosthetic valve performance. Composite endpoints for TAVI safety and effectiveness were also recommended.ConclusionAlthough consensus criteria will invariably include certain arbitrary features, an organized multidisciplinary process to develop specific definitions for TAVI clinical research should provide consistency across studies that can facilitate the evaluation of this new important catheter-based therapy. The broadly based consensus endpoint definitions described in this document may be useful for regulatory and clinical trial purposes.

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Section: Prosthetic Valve Performancementioning

confidence: 99%

Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium

Leon

Piazza

Nikolsky

et al. 2011

European Heart Journal

905

635

View full text Add to dashboard Cite

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“…Importantly, the presence of a concomitant mitral prosthesis will cause significant shadowing and obscure the LVO tract. 129,130 In such cases it is critical to evaluate the prosthesis from transgastric transducer positions.…”

Section: Doppler Evaluation Of Severity Of Prosthetic Armentioning

confidence: 99%

New Recommendations For Evaluation Of Prosthetic Valves With Echocardiography And Doppler Ultrasound

Zoghbi

2010

Methodist DeBakey Cardiovascular Journal

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“…Intermittent alteration of mechanical leaflets in mitral prosthesis is a well-known phenomenon as a result of varying degrees of intermittent obstruction to the disk opening related to cyclic changes in atrial-ventricular gradients. On the contrary intermittent aortic dysfunction in mechanical aortic valves is a very rare condition and cyclic restriction of leaflet motion may not be easily explained by hemodynamic cyclic changes while it could be related to "pannus" interference that impedes normal closure of disks in an intermittent way [4,5]. TEE was performed but it was not able to identify the intimal flap.…”

Section: Discussionmentioning

confidence: 99%

Unsuspected Aortic Dissection in Patient with Diagnosis of Prosthesis Aortic Valve Dysfunction

Simon¹

2014

JCCR

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A 74-year-old woman was admitted to our hospital for acute pulmonary oedema. She had undergone aortic valve replacement with a Bicarbon 23A 16 years before because aortic stenosis caused by rheumatic valve disease and during the same operation she received a mitral valve repair (commissurotomy) for mitral valve stenosis. Until February 2008 her clinical condition was good. On February 2012 she was admitted in hospital for atrial flutter with high ventricular response. She was treated with amiodarone and than after 4 days she was discharge. Transthoracic echocardiography (TTE) was performed and showed a left ventricle with normal volume and diameter, with ipokinesia of the apex, EF 45%, a normal aortic prosthesis motion, and a native mitral valve with mild stenosis. On March 2012 she was admitted again in our hospital for acute pulmonary oedema, auscultation revealed normal prosthetic valve opening and closing clicks and a grade 2/6 ejection systolic murmur. TTE showed an intermittent aortic prosthesis dysfunction with mean (24 mm Hg) and peak (100 mm Hg) aortic gradients, they were higher than previous values recorded one month before. Multiplan transesophageal echocardiography (TEE) was, therefore, performed and confirmed TTE data. Severe aortic valve prosthesis regurgitation occurred intermittently and than a pannus or a thrombus was suspected do to a partial occlusion of the leaflets. A cardiac catheterisation (CC) and a cinefluoroscopy (CF) were performed. On CC the coronary artery was without stenosis and the prosthesis valve was good. CF allowed proper visualization of the disks showing normal systolic motion and the prosthesis aortic valve has a good motion of the bileaflet ( Figure 1). While the diagnosis of an intermittent aortic prosthesis valve dysfunction was done, the patients were admitted to the operating theatre where she had an aortic and mitral valve replacement. Sternotomy was performed and extracorporeal circulation was started. An aortotomy was done and no pannus Unsuspected Aortic Dissection in Patient with Diagnosis of Prosthesis Aortic Valve Dysfunctionor thrombus was seen on the prosthesis but an intimal flap on the aortic wall was found. So the diagnosis of chronic Stanford type A aortic dissection was done. The Aortic dissection involved only the ascending aorta and the proximal part of the aortic arch. We found two tears in this part of the ascending aorta and the descending was free of dissection. In the light of that we suppose AbstractOn March 2012 a 74-year-old woman was admitted to our hospital for acute pulmonary oedema. In 1994 she had undergone aortic valve replacement with a Bicarbon 23A and mitral valve repair (commissurotomy) for mitral valve stenosis Auscultation revealed normal prosthetic valve opening and closing clicks and a grade 2/6 ejection systolic murmur. TTE showed an intermittent aortic prosthesis dysfunction with mean (24 mm Hg) and peak (100 mm Hg) aortic gradients. They were higher than previous values recorded one month before. While the diagnosis of an inte...

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Value and Limitations of Transesophageal Echocardiography in the Evaluation of Aortic Prostheses

Cited by 36 publications

References 24 publications

Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium

Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium

New Recommendations For Evaluation Of Prosthetic Valves With Echocardiography And Doppler Ultrasound

Unsuspected Aortic Dissection in Patient with Diagnosis of Prosthesis Aortic Valve Dysfunction

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