PMC9445268_01
Transthoracic and transesophageal echocardiography. Transthoracic (A-D) and transesophageal (E-H) echocardiograms demonstrate multiple PVL jets on short-axis view (B,F; Supplementary Videos 1, 2). The largest jet is in the 1 o'clock position and is well-visualized on long-axis views (D,H); (Supplementary Videos 3, 4).
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F1
Echocardiography demonstrated normal biventricular function (left ventricular ejection fraction 68%), severe mitral stenosis, multiple jets of prosthetic aortic PVL classified as either moderate or severe depending on the parameter2 (Figure 1; Supplementary Videos 1-4) and otherwise normal prosthetic valve function (peak velocity 2.16 m/sec, mean transvalvular gradient 9 mmHg, Effective Orifice Area 1.8 cm2, Effective Orifice Area Indexed 0.98 cm2/m2).
Multiparametric assessment of PVL severity. Echocardiographic quantification of jet size by planimetry (A) and by VC using glass image processing (B); (Supplementary Video 5). Angiographic assessment of PVL (C). Computed tomography showing prosthesis under-expansion (D). CMR of the largest PVL jet (E) and quantification of the total regurgitant volume and fraction (F); (Supplementary Video 6).
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F2
The largest PVL jet vena contracta (VC) area measured 0.36 cm2 (Figure 2A) with a large flow convergence, suggestive of severe PVL. However, the VC width measured 0.5 cm on glass image processing (Figure 2B; Supplementary Video 5) and the circumferential extent of the PVL was <30%, suggesting moderate PVL. Conversely, angiography found only 1+ PVL (Figure 2C). Computed tomography (CT) demonstrated that the cause of the PVL was the under-expansion of the prosthesis (Figure 2D). Cardiac magnetic resonance (CMR) phase contrast imaging allowed exact quantification of flow through the proximal aorta (Figures 2E,F; Supplementary Video 6) bypassing the need to assess multiple jets separately.