Application of Echocardiography to Support Transapical Transcatheter Aortic Valve Implantation in Patients with Aortic Regurgitation

ObjectiveTo explore the role of echocardiography in pre-procedural, peri-procedural and post-procedural stages of transapical transcatheter aortic valve implantation （TAVI） in patients with aortic regurgitation (AR).Methods31 patients with pure/dominant AR at a high risk on surgery were enrolled in this study. The degree of their aortic regurgitation was evaluated before TAVI, as well as the related diameters of aortic root and the left ventricular systolic function measured by transthoracic echocardiography (TTE). TEE was used to reevaluate the valve pathology after general anesthesia. TEE in combination with fluoroscopy provided accurate position of the prosthetic valve for implantation. TEE was also used to monitor complications and to evaluate immediate post-procedure paravalvular regurgitation. The post TAVI follow-up included valve heamodynamic status, complications, left ventricular systolic function and left ventricular mass index (LVMI) measured by TEE. ResultsTransapical TAVI was successful in 29 of the 31 patients: 23 experienced no or little paravalvular regurgitation; 6 had mild paravalvular regurgitation. The left ventricular end-diastolic diameter (LVDd) and left ventricular mass index (LVMI) of the patients decreased significantly one week after TAVI, which progressed until one month later （ P<0.05）. The left ventricular ejection (EF) of the patients also decreased one week after TAVI（ P<0.05）, but it resumed to the pre-procedural level one month later. ConclusionTransapical TAVI is a potentially safe and effective therapy for patients with pure/dominant AR at a high risk on open-heart surgery. Echocardiography plays an important role in pre-procedural evaluation, peri-procedural monitoring and post-procedural follow-up in TAVI.