Multimodal Imaging in Transcatheter Aortic Valve Replacement

Abstract

T he performance of different imaging modalities in patients undergoing transcatheter aortic valve replacement is essential for patient selection, in order to guide the procedure, and to detect and quantify acute and chronic complications of this new intervention. Proper sizing of the aortic valve annulus is one of the most important steps to accurately select prosthesis size and prevent paravalvular aortic regurgitation. In this issue of the Brazilian Journal of Invasive Cardiology (RBCI), Magalhaes, Waksman, and Pichard, from the MedStar Washington Hospital Center (Washington, DC, United States), discuss in their editorial the impact of aortic regurgitation on mortality after transcatheter aortic valve replacement, the evidence of this association, and the methodological limitations that can attenuate the establishment of a direct causal association. They comment the article by Lluberas et al., from Instituto Dante Pazzanese de Cardiologia (Sao Paulo, SP, Brazil), which assessed the incidence, clinical impact, and predictors of paravalvular regurgitation after transcatheter aortic valve replacement in the largest national series of this procedure. They recall the importance of preventive measures, such as selecting the most appropriate size and type of prosthesis for each patient, and the contribution that multimodal imaging analysis has brought to aortic annulus measurement. They mention that a fourth dimension, i.e., time, was added to annulus evaluation, as variability in the size of this structure has been observed in the different phases of the cardiac cycle.