Abstract
BackgroundObjective assessment of prosthetic paravalvular leak (PVL) is complex and challenging even in transesophageal echocardiography (TEE). Our aim was to assess the value of cardiovascular magnetic resonance (CMR) in quantifying PVL in aortic (AVR) or mitral valve (MVR) replacement.MethodsThirty-one patients (62 ± 15.1 years, 63% males) with a preliminary diagnosis of significant PVL (AVR, n-23; MVR, n = 8) were recruited. The TEE PVL grading was based on the semi-quantitative (SQ) TEE according to the VARC II PVL classification (%PVL: mild < 10%; moderate 10%–30%; severe > 30%). Non-contrast CMR studies were acquired at 1.5 T with a quantitative approach (phase-contrast velocity encoded imaging). The CMR PVL severity was classified according to regurgitant fraction (RF: (1) mild ≤ 20%, (2) moderate 21%–39%, or (3) severe ≥ 40%).ResultsAll patients revealed symptoms of heart failure (71%: New York Heart Association [NYHA] II; 91%: N-terminal pro-B-type natriuretic peptide [NT-proBNP] > 150 pg/ml) and typical cardiovascular disease risk factors. The SQ-TEE results revealed several categories: (1) mild (n = 5; 16%), (2) moderate (n = 21; 67%), and (3) severe (n = 5; 16%) PVL. However, CMR PVL RF reclassified the severity of PVL: (1) mild to moderate (in 80%), (2) moderate to severe (in 47%), and (3) severe to moderate (in 40%). The receiver operating characteristic analysis showed that SQ-TEE and CMR PVL-vol and -RF predicted the upper tertile of NT-proBNP (> 2000 pg/ml) with the best sensitivity for CMR parameters.ConclusionThe SQ-TEE showed moderate agreement with CMR and underestimated a considerable number of AVR or MVR-PVL.
Highlights
Prosthetic valve paravalvular leak (PVL) is a rare finding in patients with valve surgical prostheses
The exclusion criteria included: (1) any form of prosthesis degeneration resulting in transvalvular regurgitation on transesophageal echocardiography (TEE); one patient was excluded for transvalvular regurgitation instead of PVL, and one patient was excluded for coexistence of trans- and paravalvular regurgitations, (2) transcatheter aortic valve implantation (TAVI), (3) contraindications to cardiovascular magnetic resonance (CMR), and/or (4) high probability of incomplete or nondiagnostic CMR
Study group A total of 31 consecutive patients with either aortic valve replacement (AVR)-PVL (n = 23) or mitral valve replacement (MVR)-PVL (n = 8) were enrolled into the study (62 ± 15.1 years, 63% males), and all completed a TEE and a non-contrast CMR
Summary
Prosthetic valve paravalvular leak (PVL) is a rare finding in patients with valve surgical prostheses. PVL is detected in up to 10% of patients after aortic valve replacement (AVR) and 17% of patients after mitral valve replacement (MVR). A mild leak may have no clinical consequences, a considerable number of patients with PVL will have persistent symptoms of heart failure (HF), hemolytic anemia, or even a worse clinical prognosis [3]. The surgical treatment for severe PVL is repeat surgery, which is associated with significant mortality and complication rates [4]. Objective assessment of prosthetic paravalvular leak (PVL) is complex and challenging even in transesophageal echocardiography (TEE). Our aim was to assess the value of cardiovascular magnetic resonance (CMR) in quantifying PVL in aortic (AVR) or mitral valve (MVR) replacement
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