Echocardiographic assessment after transcatheter aortic valve replacement

Aortic stenosis is one of the most common valvular diseases, especially in the elderly. Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment of severe, symptomatic aortic stenosis. Echocardiography remains the critical diagnostic tool for procedural success, complications, and follow up. In this review we discuss the use of echocardiography for assessment of transcatheter aortic valve (TAV) function. We summarize currently available data on expected mean gradients and effective orifice area in various valve types and sizes and how it may differ from invasive measurements. We also summarize the complexities of quantifying paravalvular TAV regurgitation and its impact on clinical outcomes. The hemodynamics of a transcatheter aortic valve is highly dependent on the inflow fluid dynamics. Although high gradients are undesirable, it does not necessary correlate to worse outcomes and should be taken into account with other parameters for assessment of valve function. Accurate diagnosis of bioprosthetic valve degeneration and failure is crucial as the TAVR patient shifts to younger and less co-morbid population.