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The modern role of transoesophageal echocardiography in the assessment of valvular pathologies
Echo Research & Practice volume 4, pages R1–R13 (2017)
Abstract
Despite significant advancements in the field of cardiovascular imaging, transoesophageal echocardiography remains the key imaging modality in the management of valvular pathologies. This paper provides echocardiographers with an overview of the modern role of TOE in the diagnosis and management of valvular disease. We describe how the introduction of 3D techniques has changed the detection and grading of valvular pathologies and concentrate on its role as a monitoring tool in interventional cardiology. In addition, we focus on the echocardiographic and Doppler techniques used in the assessment of prosthetic valves and provide guidance for the evaluation of prosthetic valves. Finally, we summarise quantitative methods used for the assessment of valvular stenosis and regurgitation and highlight the key areas where echocardiography remains superior over other novel imaging modalities.
References
Sharma V, Alderton S, McNamara H, Steeds R, Bradlow W, Chenzbraun A, Oxborough D, Mathew T, Jones R, Wheeler R etal 2015 A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists. Echo Research and Practice 2 G25–G27. (doi:10.1530/ERP-15-0035)
Wheeler R, Steeds R, Rana B, Wharton G, Smith N, Allen J, Chambers J, Jones R, Lloyd G, O’Gallagher K etal 2015 A minimum dataset for a standard transoesphageal echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2 G29–G45. (doi:10.1530/ERP-15-0024)
Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL etal 2010 European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). European Journal of Echocardiography 11 307–332. (doi:10.1093/ejechocard/jeq031)
Flachskampf FA, Wouters PF, Edvardsen T, Evangelista A, Habib G, Hoffman P, Hoffmann R, Lancellotti P, Pepi M, for the European Association of Cardiovascular Imaging Document reviewers: Donal E & Rigo F 2014 Recommendations for transoesophageal echocardiography: EACVI update 2014. European Heart Journal–Cardiovascular Imaging 15 353–365. (doi:10.1093/ehjci/jeu015)
Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J etal 2007 Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European Heart Journal 28 230–268. (doi:10.1093/eurheartj/ehl428)
Tribouilloy C, Grigioni F, Avierinos JF, Barbieri A, Rusinaru D, Szymanski C, Ferlito M, Tafanelli L, Bursi F, Trojette F, etal 2009 Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study. Journal of the American College of Cardiology 54 1961–1968. (doi:10.1016/j.jacc.2009.06.047)
Agricola E 2004 Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart 90 406–410. (doi:10.1136/hrt.2002.009621)
Kim MS, Kim Y-J, Kim H-K, Han J-Y, Chun H-G, Kim H-C, Sohn D-W, Oh B-H, Park Y-B 2009 Evaluation of left ventricular short- and long-axis function in severe mitral regurgitation using 2-dimensional strain echocardiography. American Heart Journal 157 345–351. (doi:10.1016/j.ahj.2008.10.004)
Goldstone AB, Patrick WL, Cohen JE, Aribeana CN, Popat R, Woo YJ 2015 Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis. Annals of Cardiothoracic Surgery 4 220–229. (doi:10.3978/j.issn.2225-319X.2015.04.01)
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P etal 2014 014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129 e521–e643. (doi:10.1016/j.jtcvs.2014.05.014)
Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A etal 2012 Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Journal of Cardio-Thoracic Surgery 42 S1–S44. (doi:10.1093/ejcts/ezs455)
Deloche A, Jebara VA, Relland JY, Chauvaud S, Fabiani JN, Perier P, Dreyfus G, Mihaileanu S, Carpentier A 1990 Valve repair with Carpentier techniques. The second decade. Journal of Thoracic and Cardiovascular Surgery 99 990–1001; discussion 1001–1002.
Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E etal 2011 Percutaneous repair or surgery for mitral regurgitation. New England Journal of Medicine 364 1395–1406. (doi:10.1056/NEJMoa1009355)
Alqoofi F, Feldman T 2009 Percutaneous approaches to mitral regurgitation. Current Treatment Options in Cardiovascular Medicine 11 476–482. (doi:10.1007/s11936-009-0050-4)
Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, Whitlow PL, Gray W, Low R, Herrmann HC etal 2009 Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. Journal of the American College of Cardiology 54 686–694. (doi:10.1016/j.jacc.2009.03.077)
Wunderlich NC, Siegel RJ 2013 Peri-interventional echo assessment for the MitraClip procedure. European Heart Journal–Cardiovascular Imaging 14 935–949. (doi:10.1093/ehjci/jebib60)
Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E etal 2003 A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. European Heart Journal 24 1231–1243. (doi:10.1016/S0195-668X(03)00201-X)
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M etal 2009 Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. European Journal of Echocardiography 10 1–25. (doi:10.1093/ejechocard/jen303)
Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF 1988 Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. British Heart Journal 60 299–308. (doi:10.1136/hrt.60.4.299)
Zamorano J, Cordeiro P, Sugeng L, Perez de Isla L, Weinert L, Macaya C, RodrÃguez E, Lang RM 2004 Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach. Journal of the American College of Cardiology 43 2091–2096. (doi:10.1016/j.jacc.2004.01.046)
Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL & Scientific Document Committee of the European Association of Cardiovascular Imaging 2013 Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. European Heart Journal–Cardiovascular Imaging 14 611–644. (doi:10.1093/ehjci/jet105)
Muraru D, Badano LP, Vannan M, Iliceto S 2012 Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. European Heart Journal–Cardiovascular Imaging 13 541–555. (doi:10.1093/ehjci/jes075)
Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS, Velayudhan DE, Rajdev S, Patel V 2005 Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Echocardiography 22 775–781. (doi:10.1111/j.1540-8175.2005.00171.x)
Tribouilloy C, Avinée P, Shen WF, Rey JL, Slama M, Lesbre JP 1991 End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction. British Heart Journal 65 37–40. (doi:10.1136/hrt.65.1.37)
Myerson SG 2012 Heart valve disease: investigation by cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance 14 7.. (http://dx.doi.org/doi:1532-429X-14-7">doi:10.1186/1532-429X-14-7)
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M 2009 Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Journal of the American Society of Echocardiography 22 1–23; quiz 101–102. (doi:10.1016/j.echo.2008.11.029)
Gripari P, Ewe SH, Fusini L, Muratori M, Ng AC, Cefalù C, Delgado V, Schalij MJ, Bax JJ, Marsan NA etal 2012 Intraoperative 2D and 3D transoesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation. Heart 98 1229–1236. (doi:10.1136/heartjnl-2012-301998)
Tsang W, Bateman MG, Weinert L, Pellegrini G, Mor-Avi V, Sugeng L, Yeung H, Patel AR, Hill AJ, Iaizzo PA etal 2012 Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart 98 1146–1152. (doi:10.1136/heartjnl-2012-302074)
Badano LP, Muraru D, Enriquez-Sarano M 2013 Assessment of functional tricuspid regurgitation. European Heart Journal 34 1875–1885. (doi:10.1093/eurheartj/ehs474)
Gonzalez-Vilchez F, Zarauza J, Vazquez de Prada JA, MartÃn Durán R, Ruano J, Delgado C, Figueroa A 1994 Assessment of tricuspid regurgitation by Doppler color flow imaging: angiographic correlation. International Journal of Cardiology 44 275–283. (doi:10.1016/0167-5273(94)90292-5)
Yacoub MH, Takkenberg JJ 2005 Will heart valve tissue engineering change the world? Nature Clinical Practice Cardiovascular Medicine 2 60–61. (doi:10.1038/ncpcardio0112)
Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, heria BK, Levine RA, Marx GR, Miller FA Jr, etal 2009 Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. Journal of the American Society of Echocardiography 22 975–1014; quiz 1082–1084. (doi:10.1016/j.echo.2009.07.013)
Pibarot P, Dumesnil JG 2000 Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. Journal of the American College of Cardiology 36 1131–1141. (doi:10.1016/S0735-1097(00)00859-7)
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B etal 2015 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European Heart Journal 36 3075–3128. (doi:10.1093/eurheartj/ehv319)
Cabell CH, Pond KK, Peterson GE, Durack DT, Corey GR, Anderson DJ, Ryan T, Lukes AS, Sexton DJ 2001 The risk of stroke and death in patients with aortic and mitral valve endocarditis. American Heart Journal 142 75–80. (doi:10.1067/mhj.2001.115790)
Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, Casalta JP, Gouvernet J, Derumeaux G, Iarussi D etal 2005 Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 112 69–75. (doi:10.1161/CIRCULATIONAHA.104.493155)
Dickerman SA, Abrutyn E, Barsic B, Bouza E, Cecchi E, Moreno A, Doco-Lecompte T, Eisen DP, Fortes CQ, Fowler VG Jr etal 2007 The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). American Heart Journal 154 1086–1094. (doi:10.1016/j.ahj.2007.07.023)
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Wamil, M., Bull, S. & Newton, J. The modern role of transoesophageal echocardiography in the assessment of valvular pathologies. Echo Res Pract 4, R1–R13 (2017). https://doi.org/10.1530/ERP-16-0034
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DOI: https://doi.org/10.1530/ERP-16-0034