Abstract 3738: Echocardiography and Percutaneous Aortic Valve Placement
BACKGROUND. Percutaneous aortic valve placement has the potential to revolutionize the treatment of aortic valve disease but has been guided only by fluoroscopy and limited by technical constraints. Precise positioning of the valve is critical and should minimize the occurrence of paravalvar regurgitation or device migration. Accordingly, echocardiographers must become familiar with the specific imaging aspects of valve positioning to ensure optimal outcomes. We sought to determine the usefulness and limitations of echocardiography in optimizing percutaneous placement of 23 or 26 mm Cribier-Edwards stent mounted equine pericardial prostheses retrograde from the femoral artery.
METHODS AND RESULTS. Patients had transthoracic echocardiography (TTE) prior to the procedure to assess aortic annular dimension, valve hemodynamics, and bulky aortic valve calcium. Patients with small annuli or bulky calcium were unsuitable for device placement. 43 patients underwent successful percutaneous valve placement. 30 patients had TEE during device placement. TEE accurately determined annular dimension, was useful in device size selection, and successfully guided device placement in most. Utility was limited if heavy calcification acoustically shadowed the device. All patients had a significant increase in aortic valve area from 0.60 cm2 to 1.7 cm2 (p<0.001). Aortic regurgitation (predominantly posterior paravalvar) was common in patients undergoing successful deployment but was graded trivial or mild in most cases. Minimal apparent device recoil immediately following placement has been observed. Careful long-term observation will be required to elucidate the potential effect of recoil, however no late valve failure has been observed.
CONCLUSION. Echocardiography has an important role in case selection, in guidance of device placement and detection of complications of percutaneous aortic valve placement.