Pericardial effusion following transcatheter aortic valve implantation: echocardiography and multi-detector row computed tomography evaluation.

Abstract

Although pericardial effusion (PE) early after transcatheter aortic valve implantation (TAVI) has been reported in few registries, late PE at follow-up remains unexplored. Particularly, after transapical TAVI, diagnosis of PE with transthoracic echocardiography (TTE) may be challenging. The present evaluation assessed the incidence of PE early after TAVI and at 1month follow-up using TTE and multi-detector computed tomography (MDCT). The agreement between TTE and MDCT to diagnose the presence and severity of PE at 1month follow-up was evaluated. Overall 293 patients undergoing TAVI were included. Pre-discharge TTE was performed in all patients. At 1month, repeat TTE was performed in 234 patients and additional MDCT evaluation in 143 patients. Pre-discharge small and moderate PE was observed in 74.1 and 4.1% of patients, respectively, whereas significant PE was diagnosed in 8 (2.7%) patients without differences between procedural access: 1.6 versus 3.6% for transfemoral and transapical respectively, p=0.474. At 1month new-onset moderate PE was noted in 6 (2.5%) patients all of who underwent transapical TAVI. MDCT and TTE disagreed on the grade of PE in 38 patients. Importantly, one patient with small PE on TTE was considered having moderate PE and two patients with small and moderate PE were considered having large PE. Also, two patients with moderate PE on echocardiography were considered small PE on MDCT. In conclusions, significant PE early after TAVI is infrequent. The prevalence of small and moderate PE remains stable at 1month follow-up. MDCT refines the diagnosis of significant PE.