Transcatheter Aortic Valve Replacement

 

Image Library  >> Valvular Disease >> Transcatheter Aortic Valve Replacement (TAVR)                    Author: Atif Qasim, M.D.

TEE Baseline Images - Severe Aortic Stenosis

Midesophageal views

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Transcatheter Aortic Valve Replacement (TAVR) is a new technique reserved for a certain subset of aortic stenosis patients whereby a new bioprosthetic aortic valve is placed percutaneously within the native stenosed calcific valve. It is performed in a hybrid operating room and TEE is an essential part of the procedure. These baseline images are of the standard short axis, long axis, and 5 chamber TEE views and demonstrate severe aortic stenosis. There is also some baseline aortic regurgitation seen via color Doppler.

 

TEE Baseline Images - Aortic Valve Gradients

Deep Transgastric

Gradients across the aortic valve were measured in the deep transgastric view with continuous wave Doppler and show an increased mean and peak valve gradient and peak velocity consistent with severe aortic stenosis.

TEE Baseline Images - Aortic Valve Planimetry

Short axis

In this short axis view the aortic valve area was planimetered at 0.6 cm^2.
 

Baseline Images - LV function

Multiple views

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Views from the midesophageal and transgastric position of the LV demonstrate a preserved ejection fraction with left ventricular hypertrophy in this individual.
 

TEE - Balloon Valvuloplasty

Long Axis

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The initial set of maneuvers is to perform balloon aortic valvuloplasty to allow for more adequate room for placement of the percutaneous valve. This is the first valvuloplasty attempt, done with rapid RV pacing to cause ventricular standstill, however significant motion of the balloon did now allow for adequate inflation within the valve itself.

TEE - Balloon Valvuloplasty

Long Axis

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A second valvuloplasty is performed that is more successful and well positioned throughout inflation.

TEE - Percutaneous Valve Positioning

Long Axis

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The new percutaneous aortic valve is then carefully positioned within the confines of the old valve.
 

TEE - Valve Deployment

Long Axis

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The percutaneous aortic valve is opened using a large balloon, shown here filled with contrast bubbles, during rapid pacing of the right ventricle, again to create ventricular standstill.

TEE - Post Deployment

Short Axis

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Here is the short axis view of the valve post deployment. It appears well seated with little movement.

TEE - Post Deployment

Color Doppler

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Color Doppler shows there are some areas of small perivalvular leak (not uncommon after this procedure) and that the valve itself has minimal regurgitation.
 

TEE - Post Deployment, Gradient Measurements

Deep Transgastric

Repeat measurements of the gradients show that it has significantly decreased.