eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
1/2019
vol. 15
 
Share:
Share:
more
 
 
abstract:
Image in intervention

Innovative multi-modality imaging to assess paravalvular leak

Marc-Antoine Isorni, Sebastien Monnot, Martin Kloeckner, Benoit Gerardin, Sebastien Hascoet

Adv Interv Cardiol 2019; 15, 1 (55): 120–122
Online publish date: 2019/04/04
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Imaging is a key point in the guidance of transcatheter treatment of paravalvular leak (PVL). Mostly explored by echocardiography, this imaging modality is limited by the acoustic shadowing from the valve prosthesis [1].
Cardiac computed tomography may be useful to assess anatomical characteristics (size, location, path) but is exposed to beam hardening artifacts and to cardiac movements [2]. Conventional cardiac magnetic resonance (CMR) seems to be relevant for functional evaluation of PVL after transcatheter aortic valve replacement, but is highly sensitive to metallic artefacts [3]. The question of a complete evaluation of paraprosthetic leakage therefore remains open and no conventional modality seems satisfactory. Because this question is also frequent in clinical practice, we have been led to consider an innovative imaging modality to complete the multimodal analysis; 4D flow imaging. We considered exploring new imaging techniques after percutaneous closure failure for a paravalvular mitral valve leak. The hypothesis put forward was a misguided selection of the prosthesis and therefore an unsatisfactory assessment of the leak. The initial evaluation was performed according to our usual practice, based on echocardiography (transthoracic and transesophageal) and cardiac computed tomography (CT) (Figures 1, 2). Considering that this initial evaluation was unsatisfactory, we favored an additional imaging modality rather than renewing potentially invasive or deleterious examinations. Cardiac magnetic resonance was then performed at 1.5 Tesla (Discovery MR 450 W, GEHC) in order to assess 4D flow imaging (TR 4.3, TE 2.4, VPS 3, 1.4 × 1.4 × 1.2 mm) (Figure 3). 4D flow imaging is an innovative modality of blood flow imaging with 3-dimensional time-resolved, phase-contrast cardiac magnetic resonance. This technique has already shown its feasibility and interest in many cardiovascular areas, including the study of prosthetic valves [4, 5]. Full examination was done in a free-breathing, single, acquisition (acquisition time 8 min, post-processing time 20 min) [6]. Retrospective valve tracking was used to quantify PVL after post-processing (Arterys, California, USA). Inlet and outlet dimensions were determined using planimetry on dynamic and almost isotropic acquisition after adjustment for every timeframe and direction of the regurgitant flow. Hemodynamic characteristics could be determined by direct measurement giving celerity and regurgitant volume....


View full text...
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe