Role of echocardiography in percutaneous aortic valve implantation.
OBJECTIVE
This study was designed to investigate the usefulness and limitations of echocardiography in optimizing the outcome of percutaneous aortic valve implantation.


BACKGROUND
Percutaneous aortic valve implantation is an emerging technique that has the potential to revolutionize the treatment of aortic valve disease. To date, however, the technique has been limited by technical constraints. Precise positioning of the valve is essential to minimize the potential for paravalvular regurgitation or device migration. Initial experience with device placement utilized fluoroscopic guidance only.


METHODS
Candidates for percutaneous aortic valve implantation were evaluated with transthoracic echocardiography (TTE) to assess aortic annular dimension and aortic valve hemodynamics. Fifty consecutive patients were deemed suitable for percutaneous aortic valve implantation. Seventy-four percent (37 of 50) of patients underwent transesophageal echocardiography (TEE) during the procedure.


RESULTS
Eighty-six percent (43 of 50) of patients had successful implantation, of which 77% (33 of 43) had TEE. Transthoracic echocardiography was used to determine annular dimension and was useful in guiding correct device sizing. Transesophageal echocardiography was able to successfully guide device implantation in 97% (33 of 34) of patients in whom the native valve was crossed with the percutaneous heart valve. Transesophageal echocardiography was used for the early detection of paravalvular aortic regurgitation (AR) and complemented fluoroscopy in the detection of complications. Additional balloon dilatation of the percutaneous heart valve was performed in 12 patients because of significant paravalvular AR, with 7 showing improvement in AR grade. After the procedure, early outcomes were evaluated using TTE. All patients in whom the device was successfully placed (43 of 50) had improvement in their aortic stenosis. Paravalvular AR, although present in many patients, is usually mild and has not emerged as a significant problem.


CONCLUSIONS
Echocardiography has an important role in case selection, in guiding device placement, and in detecting complications of percutaneous aortic valve implantation.
Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. rmoss@providencehealth.bc.ca
Robert R
RR
Moss
Emma
E
Ivens
Sanjeevan
S
Pasupati
Karin
K
Humphries
Christopher R
CR
Thompson
Brad
B
Munt
Ajay
A
Sinhal
John G
JG
Webb
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002404:Catheterization; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional