ISSN 1671-5411 CN 11-5329/R

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Volume 17 Issue 12
Dec.  2020
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Article Contents
Ming-Hu XIAO, Yong-Jian WU, Jing-Jin WANG, Guang-Yuan SONG, Jian-De WANG, Zhen-Hui ZHU, Xu WANG, Zhen-Yan ZHAO, Hao WANG. Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation. J Geriatr Cardiol 2020; 17(12): 766-774. doi: 10.11909/j.issn.1671-5411.2020.12.006
Citation: Ming-Hu XIAO, Yong-Jian WU, Jing-Jin WANG, Guang-Yuan SONG, Jian-De WANG, Zhen-Hui ZHU, Xu WANG, Zhen-Yan ZHAO, Hao WANG. Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation. J Geriatr Cardiol 2020; 17(12): 766-774. doi: 10.11909/j.issn.1671-5411.2020.12.006

Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation

doi: 10.11909/j.issn.1671-5411.2020.12.006
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  • Corresponding author:

    Hao WANG, MD, PhD, Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. E-mail: fuwaiwanghao@163.com

  • Received Date: 2020-09-03
  • Accepted Date: 2020-11-30
  • Rev Recd Date: 2020-10-15
  • Available Online: 2020-12-28
  • Publish Date: 2020-12-26
  •  Background The effective orifice area (EOA) is utilized to characterize the hemodynamic performance of the transcatheter heart valve (THV). However, there is no consensus on EOA measurement of self-expanding THV. We aimed to compare two echocardiographic methods for EOA measurement following transcatheter self-expanding aortic valve implantation. Methods EOA was calculated according to the continuity equation. Two methods were constructed. In Method 1 and Method 2, the left ventricular outflow tract diameter (LVOTd) was measured at the entry of the prosthesis (from trailing-to-leading edge) and proximal to the prosthetic valve leaflets (from trailing-to- leading edge), respectively. The velocity-time integral (VTI) of the LVOT (VTILVOT) was recorded by pulsed-wave Doppler (PW) from apical windows. The region of the PW sampling should match that of the LVOTd measurement with precise localization. The mean transvalvular pressure gradient (MG) and VTI of THV was measured by Continuous wave Doppler. Results A total of 113 consecutive patients were recruited. The mean age was 77.2 ± 5.5 years, and 72 patients (63.7%) were male. EOA1 with the use of Method 1 was larger than EOA2 (1.56 ± 0.39 cm2 vs. 1.48 ± 0.41 cm2, P = 0.001). MG correlated better with the indexed EOA1 (EOAI1) (r = -0.701, P < 0.001) than EOAI2 (r = -0.645, P < 0.001). According to EOAI (EOAI ≤ 0.65 cm2/m2, respectively), the proportion of sever prosthesis-patient mismatch with the use of EOA1 was lower than EOA2 (12.4% vs. 21.2%, P < 0.05). Compared with EOA2, EOA1 had lower interobserver and intra-observer variability (intra: 0.5% ± 17% vs. 3.8% ± 22%, P < 0.001; inter: 1.0% ± 9% vs. 3.5% ± 11%, P < 0.001). Conclusions For transcatheter self-expanding valve EOA measurement, LVOTd should be measured in the entry of the prosthesis stent (from trailing-to-leading edge), and VTILVOT should match that of the LVOTd measurement with precise localization.
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  • [1]
    Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic- valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370: 1790-1798. doi: 10.1056/NEJMoa1400590
    [2]
    Gerckens U, Tamburino C, Bleiziffer S, et al. Final 5-year clinical and echocardiographic results for treatment of severe aortic stenosis with a self-expanding bioprosthesis from the ADVANCE Study. Eur Heart J 2017; 38: 2729-2738. doi: 10.1093/eurheartj/ehx295
    [3]
    Kaya D, Tanriverdi Z, Dursun H, et al. Echocardiographic outcomes of self-expanding CoreValve versus balloon-expandable Edwards SAPIEN XT valves: the comparison of two bioprosthesis implanted in a single centre. Int J Cardiovasc Imaging 2016; 32: 1371-1378. doi: 10.1007/s10554-016-0924-y
    [4]
    van Mourik MS, van der Velde N, Mannarino G, et al. Value of a comprehensive geriatric assessment for predicting one- year outcomes in patients undergoing transcatheter aortic valve implantation: results from the CGA-TAVI multicentre registry. J Geriatr Cardiol 2019; 16: 468-477.
    [5]
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation 2009; 119: 1034-1048. doi: 10.1161/CIRCULATIONAHA.108.778886
    [6]
    Jilaihawi H, Chin D, Spyt T, et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis. Eur Heart J 2010; 31: 857-864. doi: 10.1093/eurheartj/ehp537
    [7]
    Oh JK, Little SH, Abdelmoneim SS, et al. Regression of paravalvular aortic regurgitation and remodeling of self-expanding transcatheter aortic valve: an observation from the CoreValve U.S. Pivotal Trial. JACC Cardiovasc Imaging 2015; 8: 1364-1375. doi: 10.1016/j.jcmg.2015.07.012
    [8]
    Doddamani S, Bello R, Friedman MA, et al. Dmonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: iplications for the determination of aortic valve area. Echocardiography 2007; 24: 860-866. doi: 10.1111/j.1540-8175.2007.00479.x
    [9]
    Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009; 22: 1-23. doi: 10.1016/j.echo.2008.11.029
    [10]
    Le Ven F, Freeman M, Webb J, et al. Impact of low flow on the outcome of high-risk patients undergoing transcatheter aortic valve replacement. J Am Coll Cardiol 2013; 62: 782-788. doi: 10.1016/j.jacc.2013.05.044
    [11]
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310.
    [12]
    Gillinov AM, Blackstone EH, Rodriguez LL. Prosthesis-patient size: measurement and clinical implications. J Thorac Cardiovasc Surg 2003; 126: 313-316. doi: 10.1016/S0022-5223(02)73223-6
    [13]
    Badano L, Mocchegiani R, Bertoli D, et al. Normal echocardiographic characteristics of the Sorin Bicarbon bileaflet prosthetic heart valve in the mitral and aortic positions. J Am Soc Echocardiogr 1997; 10: 632-643. doi: 10.1016/S0894-7317(97)70026-9
    [14]
    Kumar R, Latib A, Colombo A, et al. Self-expanding prostheses for transcatheter aortic valve replacement. Prog Cardiovasc Dis 2014; 56: 596-609. doi: 10.1016/j.pcad.2014.03.002
    [15]
    Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009; 22: 975-1014. doi: 10.1016/j.echo.2009.07.013
    [16]
    Zoghbi WA, Asch FM, Bruce C, et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valverepair or replacement: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2019; 32: 431-475. doi: 10.1016/j.echo.2019.01.003
    [17]
    Clavel MA, Rodés-Cabau J, Dumont É, et al. Validation and characterization of transcatheter aortic valve effective orifice area measured by Doppler echocardiography. JACC Cardiovasc Imaging 2011; 4: 1053-1062. doi: 10.1016/j.jcmg.2011.06.021
    [18]
    Ng AC, Delgado V, van der Kley F, et al. Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography. Circ Cardiovasc Imaging 2010; 3: 94-102. doi: 10.1161/CIRCIMAGING.109.885152
    [19]
    Shames S, Koczo A, Hahn R, et al. Flow characteristics of the SAPIEN aortic valve: the importance of recognizing in-stent flow acceleration for the echocardiographic assessment of valve function. J Am Soc Echocardiogr 2012; 25: 603-609. doi: 10.1016/j.echo.2012.02.013
    [20]
    Sirois E, Mao W, Li K, et al. Simulated transcatheter aortic valve flow: implications of elliptical deployment and under-expansion at the aortic annulus. Artif Organs 2018; 42: E141-E152. doi: 10.1111/aor.13107
    [21]
    Tzikas A, Piazza N, Geleijnse ML, et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the medtronic CoreValve system in patients with aortic stenosis. Am J Cardiol 2010; 106: 255-260. doi: 10.1016/j.amjcard.2010.02.036
    [22]
    Muñoz-García AJ, Muñoz-García M, Carrasco-Chinchilla F, et al. Incidence and clinical outcome of prosthesis-patient mismatch after transcatheter aortic valve implantation with the CoreValve prosthesis. Int J Cardiol 2013; 167: 1074-1076. doi: 10.1016/j.ijcard.2012.10.062
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