Transcatheter edge-to-edge repair (TEER) is at present a well established interventional procedure for the treatment of mitral regurgitation (MR). Echocardiography is an essential imaging modality for peri-interventional assessment of TEER. Pre-procedural echocardiographic assessments, which include grading of MR severity, determining MR etiology and mechanisms, and analyzing mitral valve morphology, helps to determine patient eligibility and plan the procedure. Echocardiography is also indispensable in intra-procedural guidance, such as atrial septum puncture, advancing the device to the target position, and leaflets capture. In addition, echocardiography is important in immediate result evaluation, complication detection and patient follow up after the procedure.
Before transcatheter aortic valve replacement (TAVR), echocardiography is the first choice for preoperative screening of suitable patients, which can be used to observe the morphology of aortic valve, determine the cause of aortic stenosis, and evaluate the severity of aortic stenosis and other cardiac structure and function. During TAVR procedure, echocardiography is mainly used for real-time monitoring of complications and immediate postoperative evaluation. After TAVR, echocardiography can be used to evaluate the shape and function of the prosthesis valve and monitor long-term complications. This article reviews the research progress of echocardiography in TAVR for guiding clinical practice.
Current guidelines recommend follow-up observation for moderate aortic stenosis (MAS), but clinical evidence shows that its prognosis is poor, especially when combined with left ventricular systolic dysfunction, the risk of death and hospitalization for heart failure is significantly increased. With the technical maturity and device development of transcatheter aortic valve replacement (TAVR), its therapeutic potential in MAS has attracted attention. This paper systematically reviewes the risk stratification indicators of MAS and the clinical research results of early TAVR intervention, and analyzes the key clinical issues such as patient selection and operation timing. It points out that early TAVR may improve the prognosis and quality of life of some high-risk MAS patients, but its wide clinical application still needs more evidence-based medical evidence support.
Quadricuspid aortic valve (QAV) is a rare congenital heart disease, and its long-term lesion type is mainly reflux. The application of transcatheter aortic valve replacement (TAVR) in such patients is extremely rare. This article reports a case of an elderly patient with QAV complicated with severe regurgitation and small subvalvular membrane. Through preoperative evaluation and guidance from the cardiac team discussion, a relatively high oversize rate retrievable valve was selected and the TAVR surgery was successfully completed. At the same time, the valve implantation depth was adjusted to cover the subvalvular membrane. After surgery, the patient’s symptoms such as palpitations were significantly improved. No obvious perivalvular leakage or regurgitation was observed. It provides a reference for TAVR surgical plans for such patients.
This article reports a case of transjugular transcatheter tricuspid valve replacement (TTVR) for persistent severe tricuspid regurgitation after transcatheter mitral valve replacement. The patient was an 80 year old female who underwent transcatheter mitral valve replacement at the Department of Cardiology, West China Hospital, Sichuan University, two months before admission. After the surgery, her condition worsened due to unimproved tricuspid regurgitation and right heart failure. After admission, the patient underwent transjugular TTVR under general anesthesia. With the assistance of cardiac ultrasound and X-ray fluoroscopy, an artificial valve was successfully implanted, and tricuspid regurgitation was relieved. The patient’s surgery went smoothly, and the condition improved significantly 25 days after surgery. The patient was discharged 34 days after surgery.
In recent years, transcatheter mitral valve replacement is a focused issue in the field of valve intervention, which brings hope to mitral regurgitation patients who are not suitable for surgical thoracotomy. This paper presents the case of echocardiography-guided transseptal mitral valve replacement with the HighLife system in an elderly female patient with severe mitral regurgitation who failed to respond to standard medical therapy. During the procedure, echocardiography was used to guide the wire looping, cinching, atrial septal puncture, ring closure, atrial septal balloon dilatation, prosthetic valve implantation and immediate postoperative evaluation. Echocardiography plays an important role in transseptal mitral valve replacement, which can help the procedural process and improve the safety of the procedure.
Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.
Objective To compare the efficacy and safety of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV). Methods This retrospective study included 252 consecutive patients with severe and symptomatic aortic valve stenosis undergoing TAVR in West China Hospital form April 2012 to September 2017, in whom 4 patients were excluded because of valve failure after surgical aortic valve replacement. Results Of the 248 patients, 131 had BAV and 117 had TAV. Baseline characteristics were similar between the two groups, including age [(73.56±6.35) vs. (74.31±6.35) years, P=0.354], male proportion (51.9% vs. 63.2%, P=0.072). Society of Thoracic Surgeons score for BAV patients was lower than that for TAV patients [(7.56±4.01)% vs. (8.78±5.14)%, P=0.037]. Procedural success rate was high in both BAV and TAV groups (95.4% vs. 98.3%, P=0.359). There was no difference in 30-day all-cause mortality (6.1% vs. 2.6%, P=0.176) between the two groups; the aortic valve maximum velocity of valve hemodynamics after TAVR was similiar [(2.39±0.53) vs. (2.31±0.45) m/s, P=0.262] between the two groups. Conclusions Patients with BAV show similar procedural and clinical outcomes to patients with TAV. Therefore, TAVR appears to be a safe and effective procedure for patients with BAV as well as those with TAV.