title: Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme.
abstract: Paravalvular regurgitation (PVR) is a frequent complication of transcatheter aortic valve replacement that has been shown to be associated with increased mortality. The objective of this article is to review the most up-to-date information about the assessment and management of PVR and to propose a new more comprehensive and unifying scheme for grading PVR severity. A multimodality, multiparametric, integrative approach including Doppler echocardiography, cineangiography, hemodynamic assessment, and/or cardiac magnetic resonance is essential to accurately assess the severity of PVR and the underlying etiology. Corrective procedures such as balloon post-dilation, valve-in-valve, or leak closure may be considered, depending on the severity, location, and etiology of PVR.
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Department of Medicine, Laval University, Québec, Canada. Electronic address: philippe.pibarot@med.ulaval.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, New York, New York.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: Department of Medicine, Medstar Health Research Institute and Georgetown University, Washington, DC.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.affiliation: Department of Cardiology, King's College Hospital, London, United Kingdom.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Monaghan
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002932:Cineangiography; D032921:Consensus; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Doppler echocardiography; aortic regurgitation; aortic stenosis; cardiac magnetic resonance; transcatheter aortic valve replacement; transcatheter heart valve