Abstract
In this case report, we explain the reason behind observed differences in echocardiographic
and invasively measured mean aortic valve gradient after transcatheter aortic valve
implantation. A 25-mm Direct Flow valve (Direct Flow Medical Inc, Santa Rosa, CA)
was successfully implanted in a patient with severe aortic stenosis via the transfemoral
route. The discrepancy between invasive and echocardiographic measurements could be
explained by the combination of a nonflat velocity profile inside the tubular structure
of the Direct Flow valve, which can cause local low pressure fields that result in
true high gradients detected using Doppler, and pressure recovery.
Résumé
Dans cette observation, nous expliquons la raison qui sous-tend les différences observées
entre les mesures échocardiographiques et le gradient valvulaire aortique moyen mesuré
de manière effractive après l’implantation valvulaire aortique par cathéter. Une valve
Direct Flow de 25 mm (Direct Flow Medical Inc., Santa Rosa, CA) a été implantée par
voie transfémorale avec succès chez un patient atteint d’une sténose aortique grave.
L’écart entre les mesures effractives et les mesures échocardiographiques pourrait
être expliqué par la combinaison d’un profil de vitesse non plat à l’intérieur de
la structure tubulaire de la valve Direct Flow, qui peut causer des champs locaux
de basse pression entraînant des gradients véritablement élevés détectés au moyen
du Doppler et le rétablissement de la pression.
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References
- Energy loss index in aortic stenosis: from fluid mechanics concept to clinical application.Circulation. 2013; 127: 1101-1104
- Pressure recovery in aortic valve stenosis.Circulation. 1994; 89: 116-121
- Effect of stenosis geometry on the Doppler-catheter gradient relation in vitro: a manifestation of pressure recovery.J Am Coll Cardiol. 1993; 21: 1018-1025
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Thorac Cardiovasc Surg. 2013; 145: 6-23
- Treatment and clinical outcomes of transcatheter heart valve thrombosis.Circ Cardiovasc Interv. 2015; 8 (pii e001779)
Article info
Publication history
Published online: May 18, 2015
Accepted:
May 10,
2015
Received:
March 29,
2015
Footnotes
See page 1303.e3 for disclosure information.
Vasileios F. Panoulas and Azeem Latib contributed equally to this work.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
