ISSN 2996-8215
International Journal of Cardiology | Vol. 8, No. 11, November 2017 | pp. 81–88
DOI: 10.46882/2017/IJC/000104
Review Article
Multimodality Imaging Strategies for the Evaluation and Management of Post-Procedural Transcatheter Aortic Valve Implantation Complications
Sophia L. Vance¹, Christopher J. Davies²
¹Department of Cardiovascular Imaging, St Bartholomew's Hospital, London, United Kingdom
²Division of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
Abstract:
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe symptomatic aortic stenosis in elderly and high-surgical-risk populations. Despite structural refinements and growing operator expertise, periprocedural and late complications continue to impact long-term survival. This comprehensive review synthesizes the pivotal role of multimodality imaging—specifically multi-detector computed tomography (MDCT), transthoracic/transesophageal echocardiography (TTE/TEE), and cardiac magnetic resonance (CMR)—in identifying, mitigating, and managing major TAVI complications. MDCT serves as the gold standard for pre-procedural planning, allowing precise annular sizing and identification of risk factors for coronary artery obstruction or aortic root rupture (prevalence approximately 0.5% to 1.0%). Intraprocedurally, 2D and 3D TEE are vital for diagnosing acute complications, such as valve malpositioning, infolding, or pericardial effusion. Post-procedurally, evaluating paravalvular regurgitation (PVR) is essential, as moderate-to-severe PVR increases long-term mortality (pooled hazard ratio: 2.18, 95% CI: 1.64–2.90). While Doppler echocardiography remains the primary tracking tool for PVR, CMR is increasingly integrated due to its superior inter-observer reproducibility and precise volumetric regurgitant fraction quantification. Furthermore, high-resolution MDCT is required to detect subclinical leaflet thrombosis, characterized by hypo-attenuated leaflet thickening (HALT). Effective management of modern TAVI complications demands an integrated multimodality imaging approach across pre-, intra-, and post-procedural phases to optimize device performance and improve patient durability.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Multimodality imaging, Transesophageal echocardiography, Paravalvular regurgitation, Leaflet thrombosis
Received: August 12, 2012; Revised: September 24, 2012; Accepted: October 14, 2012; Published: November 19, 2017