Pitfalls and solutions in the imaging follow-up of valvular heart disease devices

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Doppler echocardiography is the standard for assessing valvular heart devices but presents unique imaging and flow dynamic challenges.
• Prosthetic valve dysfunction (PVD) diagnosis and management require careful evaluation of device function and patient hemodynamics.

Purpose of the Study:

• To highlight the limitations of echocardiography in evaluating valvular heart devices.
• To recommend a multimodality imaging strategy for diagnosing and characterizing PVD.
• To provide algorithms for assessing complications after transcatheter edge-to-edge repair.

Main Methods:

• Review of current literature on echocardiography and valvular heart devices.
• Discussion of imaging challenges and pitfalls.
• Integration of cardiac computed tomography (CT), magnetic resonance, and positron emission tomography-CT into diagnostic algorithms.
• Proposal of algorithms for assessing residual regurgitation and iatrogenic stenosis.

Main Results:

• Echocardiography's limitations in assessing valvular heart devices necessitate complementary imaging modalities.
• Multimodality imaging (CT, MRI, PET-CT) aids in confirming PVD, assessing severity, and determining etiology.
• Distinguishing structural from non-structural PVD relies on leaflet morphology, mobility, and hemodynamic changes.
• Algorithms can quantify residual regurgitation and iatrogenic stenosis post-transcatheter repair.

Conclusions:

• A multimodality imaging approach is essential for comprehensive evaluation of valvular heart devices.
• Accurate diagnosis of PVD and its mechanism requires integrating various imaging techniques.
• Proposed algorithms assist in managing complications and optimizing patient care for valvular heart disease.