Aortic regurgitation after transcatheter aortic valve implantation: mechanisms and implications

Author Barbara E. Stähli, Willibald Maier, Roberto Corti, Thomas F. Lüscher, Rolf Jenni, Felix C. Tanner


In recent years, transcatheter aortic valve implantation (TAVI) has become an established treatment option for selected high-risk patients with severe aortic stenosis (AS). Favorable results with regard to both hemodynamics and clinical outcome have been achieved with transcatheter valves.
Aortic regurgitation (AR) remains a major concern after TAVI. Echocardiography is the imaging modality of choice to assess AR in these patients due to its wide accessibility and low cost. Mostly mild residual AR has been observed in up to 70% of patients. However, as even a mild degree of AR has been associated with a decreased survival up to two years after TAVI, accurate evaluation and classification of AR is important. AR in transcatheter valves can be divided into three types according to different pathophysiological mechanisms. Besides the well-known transvalvular and paravalvular forms of regurgitation, a third form termed supra-skirtal has recently been observed. A thorough understanding of AR in transcatheter valves may allow to improve device design and implantation techniques to overcome this complication.
The aim of this review is to provide an overview of the three types of AR after TAVI focussing on the different pathophysiological mechanisms.

Large atrial myxoma mimicking severe mitral stenosis associated with right heart enlargement and severe pulmonary hypertension

Author Sunnar Leo, Kan Yang, Chunyan Weng, Zhongshu Liang


Cardiac myxomas are rare tumors of the heart and are easily misdiagnosed. We report a case of large left atrial myxoma with clinical presentation mimicking severe mitral stenosis.

The International Journal of Cardiovascular ImagingX-Ray Imaging, Echocardiography, Nuclear Cardiology Computed Tomography and Magnetic Resonance Imaging© Springer Science+Business Media Dordrecht 201310.1007/s10554-013-0197-7
Original Paper

CT predictors of post-procedural aortic regurgitation in patients referred for transcatheter aortic valve implantation: an analysis of 105 patients

Mohamed Marwan , Stephan Achenbach1, Stefan M. Ensminger2, Tobias Pflederer1, Dieter Ropers1,Josef Ludwig1, Michael Weyand2, Werner G. Daniel1 and Martin Arnold1

Department of Cardiology, University of Erlangen, Erlangen, Germany

Department of Cardiothoracic Surgery, University of Erlangen, Erlangen, Germany
Mohamed Marwan
Received: 20 August 2012Accepted: 13 February 2013Published online: 19 February 2013
Cardiac computed tomography (CT) allows accurate and detailed analysis of the anatomy of the aortic root and valve, including quantification of calcium. We evaluated the correlation between different CT parameters and the degree of post-procedural aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using the balloon-expandable Edwards Sapien prosthesis. Pre-intervention contrast-enhanced dual source CT data sets of 105 consecutive patients (48 males, mean age 81 ± 6 years, mean logEuroSCORE 34 ± 13 %) with symptomatic severe aortic valve stenosis referred for TAVI using the Edwards Sapien prosthesis (Edwards lifesciences, Inc., CA, USA) were analysed. The degrees of aortic valve commissural calcification and annular calcification were visually assessed on a scale from 0 to 3. Furthermore, the degree of aortic valve calcification as quantified by the Agatston score, aortic annulus eccentricity, aortic diameter at the level of the sinus of valsalva and at the sinotubular junction were assessed. Early post-procedural AR was assessed using aortography. Significant AR was defined as angiographic AR of at least moderate degree (AR ≥ 2). Visual assessment of the degree of aortic annular calcification as well as the Agatston score of aortic valve calcium correlated weakly, yet significantly with the degree of post-procedural AR (r = 0.31 and 0.24, p = 0.001 and 0.013, respectively). Compared to patients with AR < 2, patients with AR ≥ 2 showed more severe calcification of the aortic annulus (mean visual scores 1.9 ± 0.6 vs. 1.5 ± 0.6, p = 0.003) as well as higher aortic valve Agatston scores (1,517 ± 861 vs. 1,062 ± 688, p = 0.005). Visual score for commissural calcification did not differ significantly between both groups (mean scores 2.4 ± 0.5 vs. 2.5 ± 0.5, respectively, p = 0.117). No significant correlation was observed between the degree of AR and commissural calcification, aortic annulus eccentricity index or aortic diameters. The extent of aortic valve annular calcification, but not of commissural calcification, predicts significant post-procedural AR in patients referred for TAVI using the balloon-expandable Edwards Sapiens prosthesis.


Neuro Sculpture

Neuro Sculpture

Author Julia Buntaine


As a sculptor I aim to three-dimensionally illustrate the theories behind how billions of independent nerve cells create something that is greater than the sum of their parts. The brain is perhaps the most complex puzzle in the universe. My art seeks to give form to those mechanisms of the brain which have yet to be fully articulated. Drawing inspiration from neuroscientific and psychological literature, I create pieces that offer an interpretation on processes such as memory, thought, perception and consciousness (Figures 1-4). In order to capture the complexity and the enormity of my subject matter, I use scale as a tool to provide my viewer with an intellectual and physical experience (Figures 5,6).

Individual patient data meta-analysis for the clinical assessment of coronary computed tomography angiography: protocol of the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)

Cardiovascular Risk among Stable Individuals Suspected of Having Coronary Artery Disease with No Modifiable Risk Factors: Results from an International Multicenter Study of 5262 Patients

Accepted article: High Residual Platelet Reactivity on Clopidogrel: Its Significance and Therapeutic Challenges Torkom Armen Garabedian, Samir Alam