PMC5872675_01
Transaortic Doppler demonstrating dense aortic regurgitation signal with markedly reduced pressure half time, suggestive of severe aortic insufficiency.
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A transthoracic echocardiogram suggested flail aortic valve leaflet (Video 1), and transaortic Doppler signal was suggestive of wide-open aortic regurgitation (Figure 1).
(a) Pre-TAVI simultaneous aortic and left ventricular pressures demonstrating equalization of Ao diastolic LV end-diastolic pressures. (b) Post-TAVI hemodynamics revealing normal diastolic LV-Ao gradient and no systolic LV-Ao gradient. (c) Pre-TEE image of the bioprosthetic aortic valve during diastole shows three large regurgitant jets. (d) Post-TEE short axis of the TAVI valve during diastole shows absence of regurgitant flow. (e) Pre-TAVI aortogram shows 4+ aortic insufficiency. (f) Post-TAVI aortogram shows no aortic insufficiency and acceptable implantation depth. TAVI = transcatheter aortic valve replacement; Ao = aortic; LV = left ventricular; TEE = transesophageal echocardiogram.
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Pre-TAVI central aortic pressure was 114/30 mmHg, and left ventricular pressure was 120/30 mmHg (Figure 2(a)). Post-TAVI central aortic pressure was 90/40 mmHg with a left ventricular pressure of 90/13 mmHg (Figure 2(b)). The final TEE images and aortogram showed trivial aortic regurgitation (Figures 2(c)-2(f)).
Transaortic Doppler at 30 days after TAVI reveals mean systolic gradient of 12 mmHg and no aortic insufficiency. TAVI = transcatheter aortic valve replacement.
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An echocardiogram at that time revealed normal left ventricular size and function, no aortic insufficiency, mean transaortic gradient 12 mmHg, and calculated aortic valve area 1.0 cm2 (Video 4, Figure 3).