Echo during TAVR and PVL Occlusion

The technique of transcatheter intervention has evolved into highly complex device implantations that require careful preoperative assessment and intra-procedural guidance. Imaging techniques, too, have advanced to facilitate these procedures and assist the interventionist. Echocardiography remains the main imaging modality in assessment of transcatheter structural heart disease procedures. Trans-catheter aortic valve replacement (TAVR) has become an established and effective alternative therapeutically procedure for inoperable, high-risk and recently moderate-risk patients with symptomatic Aortic stenosis. The procedural success is greatly dependent on a comprehensive multi-modality imaging approach thorough TAVR screening and procedure. Echocardiography plays an important role in the pre-procedural assessment, Intra-procedural guidance, post-procedural monitoring and detection of complications following TAVR. Paravalvular leakage is a known complication of surgical and transcatheter valve replacement procedures. Reoperation is the method of choice for correcting prosthetic paravalvular leaks. The percutaneous repair of paravalvular leaks might represent an interesting and less invasive option for patients with high operative risk. Cardiac imaging, especially transesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. Three-dimensional (3D) TEE has shown better diagnostic accuracy compared to two-dimensional (2D) in the evaluation of leaks especially in patients with multiple defects and can be considered as gold standard imaging modality.