Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement

Abstract

Zoghbi et al 437 † More specific in peri-procedural or early post-procedural assessment. Holodiastolic flow reversal may not be seen in severe bradycardia. ‡ Dependent on aortic compliance; limits its utility in the elderly population; influenced by heart rate. §The vena contracta area is measured by planimetry of the vena contracta of the jet(s) on 2D or 3D color Doppler images in the short-axis view.k Measured as the sum of the circumferential lengths of each regurgitant jet vena contracta (not including the non-regurgitant space between the separate jets) divided by the circumference of the outer edge of the valve.

Effect of Diastolic Flow Reversal Patterns on Clinical Outcomes Following Transcatheter Aortic Valve Implantation ― An Intraprocedural Echocardiography Study ―

“…We also measured the circumferential extent of the jet, which only extended beyond the left ventricular outflow tract in the short-axis view with color Doppler, with a Nyquist limit of >50 cm/s. 8 Color gain settings were optimized to eliminate random color in areas with outflow. According to the Valve Academic Research Consortium (VARC-2) criteria, the severity of paravalvular leak (PVL) defined the following with respect to the circumferential extent of paravalvular AR in the short axis: mild (<10%), moderate (10-29%), and severe (≥30%).…”

Grading of aortic regurgitation by cardiovascular magnetic resonance and pulsed Doppler of the left subclavian artery: harmonizing grading scales between imaging modalities

“…Harmonizing grading schemes between imaging modalities. Indeed, using a unified standard grading scale for all methods as proposed in current recommendations [9,10] resulted in a lower level of agreement between CMR, LSA Doppler, and multiparametric TTE. A cut-off for severe AR set to a RF > 50% led to a lower sensitivity of up to 60% and 50%, by CMR and LSA Doppler respectively (Online Resource 1).…”

“…As a result, the cut-off value for severe AR on CMR varies from 30 to 50% [4][5][6][7][8]. Thereby, the writing groups for the evaluation of native valvular regurgitation and after percutaneous valve repair or replacement [9,10] had to reach consensus to use the same partition for AR severity as recommended for echocardiography until further data are available.…”

Impact of Leaflet Tethering on Residual Regurgitation in Patients With Degenerative Mitral Disease After Interventional Edge-to-Edge Repair

“…MR severity was assessed by the core laboratory echocardiographer using a multiparametric approach according to the current American Society of Echocardiography guidelines ( 15 ). Residual MR 2+ immediately after ValveClamp implantation was defined as at least one 2+ regurgitant jet [determined by flow convergence, vena contracta width (VCW) and vena contracta area (VCA)] or a total VCA for multiple residual jets ≥0.2 cm 2 ( 16 ). The etiology of DMR was classified as Barlow disease or fibroelastic deficiency according to the prolapse volume ( 6 ).…”