A Novel 3-Dimensional Echocardiographic Transillumination Rendering With Transparency in the Evaluation of Paravalvular Leak After Transcatheter Aortic Valve Implantation

Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) has been associated with poor prognoses, and its diagnosis is important when deciding strategies that consider post-dilatations to minimize the PVL.¹ Recently, 3-dimensional (3D) echocardiography transillumination with transparency (TrueVue Glass; Philips, Andover, MA, USA) allows new photorealistic imaging of cardiac structures, which may be viewed through tissue.²

An 83-year-old male with aortic stenosis underwent TAVI. Mild-to-moderate PVL was observed after the valve implantation (Figure A–C). In a TrueVue Glass (Figure C, Supplementary Movie 1), the location, width, and jet direction through the left ventricle of the PVL were clearly depicted; PVL decreased after post-dilatation (Figure D–F, Supplementary Movie 2).

Figure.

2D and 3D color Doppler echocardiography showed mild-to-moderate paravalvular leak (PVL) at 11 to 1 o’clock (A and B, red arrows), which was reduced by post-dilatation (D and E, red arrows), but the jet origin and direction were not identified. A TrueVue Glass showed jet origin and direction before (C, red arrow) and after post-dilatation (F, red arrow).

3D color Doppler echocardiography is useful for evaluating PVL because it can be used without anatomical restriction. However, the image analysis is time-consuming and it is not widely used for intraprocedural echocardiography. By using a TrueVue Glass, it is possible to clearly demonstrate the regurgitant origin and trajectory in real-time. Although the vena contracta width can be easily obtained from this image, there have been no published cut-off values for determining the severity of a PVL, and further studies are needed.

Disclosures

Y.J. Akashi is a member of Circulation Journal’s Editorial Team.

Supplementary Files

Supplementary Movie 1. TrueVue Glass before post-dilatation.

Supplementary Movie 2. TrueVue Glass after post-dilatation.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-20-1183

References

• 1.   Hayashida K, Lefèvre T, Chevalier B, Hovasse T, Romano M, Garot P, et al. Impact of post-procedural aortic regurgitation on mortality after transcatheter aortic valve implantation. JACC Cardiovasc Interv 2012; 5: 1247–1256.
• 2.   Karagodin I, Addetia K, Singh A, Dow A, Rivera L, DeCara JM, et al. Improved delineation of cardiac pathology using a novel three-dimensional echocardiographic tissue transparency tool. J Am Soc Echocardiogr 2020; 33: 1316–1323.