Treatment of Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement | Patient Case Quiz
An 86 year old woman presented to clinic with persistent shortness of breath and lower extremity edema after transcatheter aortic valve replacement (TAVR). She had undergone implantation of a 23-mm Edwards SAPIEN bioprosthetic valve for severe calcific aortic stenosis one month prior to presentation via a transfemoral approach. Clinical evaluation was notable for a blood pressure of 138/67, bilateral pitting lower extremity edema, and a new holodiastolic murmur. The patient was referred for transthoracic echocardiography (Figure 1) and cardiovascular magnetic resonance (CMR) imaging (Figure 2 and Videos 1-3) for further evaluation of suspected paravalvular leak (PVL).
Two-dimensional transthoracic echocardiographic parasternal long axis image demonstrating severe paravalvular leak (arrow).
Representative views of the paravalvular regurgitation on cardiac magnetic resonance imaging (arrows). Ao = aorta. LA = left atrium. LV = left ventricle. RA = right atrium. RV = right ventricle.
Transverse view of the paravalvular leak on cardiac magnetic resonance imaging. Backflow of blood is seen in the left ventricular outflow tract as the left ventricle relaxes during diastole.
Sagittal view of the paravalvular leak on cardiac magnetic resonance imaging.
Coronal view of the paravalvular leak on cardiac magnetic resonance imaging.
Which of the following statements about PVL after TAVR is true?