Echocardiographic evaluation of paravalvular aortic regurgitation of a patient with recurrent aortic valve replacements
Paravalvular regurgitation (PVR) is a serious complication after surgical valve replacement. Echocardiography is the gold standard technique to assess the severity of PVR with an integrated approach.
A 48-year-old male underwent aortic valve replacement due to infective endocarditis (IE). During in-hospital cardiac rehabilitation after a redo surgery for a new IE three years later, an echo-free anterior space around the valve with several PVRs through transthoracic echocardiography (TTE) was identified. On transesophageal echocardiography (TOE) a double PVR (anterior and posterior) with abscessual cavity was detected. The patient’s conditions worsened within six months with hemodynamic instability: a massive PVR due to a large abscess cavity next to the right cusp was confirmed by TTE and TOE and a third surgery was carried out. On the third admission at our Rehabilitation Unit the echo features were normal. Patient did not report any cardiovascular symptoms at 1 year follow-up.
Safi AM, Kwan T. Paravalvular regurgitation: a rare complication following valve replacement surgery. Angiology 2000;51:479-87. DOI: https://doi.org/10.1177/000331970005100605
Zoghbi WA, Asch FM, Bruce C, et al. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair 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. Erratum in: [No authors listed] J Am Soc Echocardiogr 2019;32:914-7. J Am Soc Echocardiog 2019;32:431-75. DOI: https://doi.org/10.1016/j.echo.2019.01.003
Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis - The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2015;36:3075-23. DOI: https://doi.org/10.1093/eurheartj/ehv319
Summers MR, Leon MB, Smith CR, et al. Prosthetic Valve Endocarditis After TAVR and SAVR - Insights From the PARTNER Trials. Circulation 2019;140:1984–94. DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.041399
Ruiz CR, Hahn RT, Alain Berrebi A, et al. Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis. An expert statement. J Am Coll Cardiol 2017;69:2067-87. DOI: https://doi.org/10.1016/j.jacc.2017.02.038
Kytӧ V, Ahtela E, J Sipilӓ J, et al. Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis. Interact Cardiovasc Thoracic Surg 2019;29:386-92. DOI: https://doi.org/10.1093/icvts/ivz122
Pinheiro CP, Rezek D, Costa EP, et al. Paravalvular regurgitation: Clinical outcomes in surgical and percutaneous treatments. Arq Bras Cardiol 2016;107:55-62. DOI: https://doi.org/10.5935/abc.20160086
Del Val Martìn D, Zamorano Gòmez JL. The role of imaging in paravalvular leak assessment. In: G Smolka, W Wojakowski, M Tendera, Editors. Transcatheter paravalvular leak closure. Springer, Singapore; 2017. p. 13-42. DOI: https://doi.org/10.1007/978-981-10-5400-6_2
Geleijnse ML, Di Martino LFM, Vletter WB, et al. Limitations and difficulties of echocardiographic short-axis assessment of paravalvular leakage after corevalve transcatheter aortic valve implantation. J Cardiovascular Ultrasound 2016;14:37. DOI: https://doi.org/10.1186/s12947-016-0080-5
Hryniewiecki T, Zatorska K, Abramczuk E, et al. The usefulness of cardiac CT in the diagnosis of perivalvular complications in patients with infective endocarditis. Eur Radiology 2019;29:4368–76. DOI: https://doi.org/10.1007/s00330-018-5965-2
Eleid MF, Cabalka AK, Malouf JF, et al. Techniques and outcomes for the treatment of paravalvular leak. Circ Cardiovasc Interv 2015;8:e001945. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.115.001945
Salaun E, Jacquier A, Theron A, et al. Value of CMR in quantification of paravalvular aortic regurgitation after TAVI. Eur Heart J Cardiovasc Imaging 2016;17:41-50.
Ghersin E, Martinez CA, Singh V, et al. ECG-Gated MDCT after aortic and mitral valve surgery. Am J Roentgenol 2014;203:W596-604. DOI: https://doi.org/10.2214/AJR.13.12404
- Abstract views: 102
- PDF: 25
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.