Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

A 75-year-old man was evaluated for a new diastolic murmur 3 months post-TAVR. Cardiac examination demonstrated a 2/6 systolic ejection murmur at the right upper sternal border and a 3/6 diastolic decrescendo murmur at the left sternal border. Transthoracic echocardiogram showed progressive left ventricular enlargement compared with immediate post-TAVR imaging. The aortic bio-prosthesis' function appeared normal on transthoracic echocardiogram (TTE). Anterior periprosthetic regurgitation (pAR) was noted by colour-Doppler in parasternal short axis (Panel A, arrow; Supplementary Data) and apical long axis (Panel B, arrow; Supplementary Data) comprising 0.7 cm of the 7.3 cm valve circumference, thus classified as mild−moderate by current guidelines (∼10% of annulus). Given clinical concern for significant pAR, aortic root angiography seemed appropriate but serum creatinine was 3.1 mg/dl precluding radiopaque contrast administration. Therefore, agitated-saline was injected directly into the aortic root during left heart catheterization and visualized by TTE. Agitated-saline densely opacified the entire left ventricle within two cardiac cycles (Panels C and D, five-chamber view, Supplementary Data), confirming severe pAR as the source of clinical findings. Transthoracic echocardiogram-guided agitated-saline aortography may be valuable for post-TAVR patients with indeterminate pAR severity, particularly those with contraindications to radiopaque contrast use. RV, right ventricle; AoV, aortic valve; LA, left atrium; Ao, aorta; LV, left ventricle.

Topic:
Issue Section:
Cardiovascular Flashlights
You do not currently have access to this article.
Download all slides