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Echo Rounds

Answer/Explanation

Norbert J. Rios, MD1; Mark Nelson2; Vigneshwar Kasirajan3

  1. Cardiothoracic Anesthesia Fellow, Department of Anesthesia, Virginia Commonwealth University, Richmond, VA
  2. Assistant Professor, Department of Anesthesia, Virginia Commonwealth University, Richmond, VA
  3. Chairman of Surgery, Virginia Commonwealth University, Richmond, VA

Question 1. Answer C, Moderate to severe

Severity of perivalvular leaks can be evaluated by measuring the circumferential extent of the jet in the short-axis view with mild <10%, moderate 10%–29%, and severe >30%.1 Flow reversal in the descending aorta also can be helpful in assessing severity. In our image of the perivalvular leak, the view is from the left ventricular outflow tract through the aortic valve showing around 25%–30% leakage.

Question 2. Answer D, All of the above

All of the above have been shown in current studies; however, one drawback for TAVR is the tendency to have more regurgitation.2 At 1 year, TAVR has been found to be slightly superior to SAVR with respect to the mean aortic valve gradient and mean valve area.3

References
  1. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation. The Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60(15):1438-1454.
  2. Hahn RT, Pibarot P, Stewart WJ, et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis. J Am Coll Cardiol. 2013;61(25):2514-2521.
  3. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-2198.

 

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