Structural and Hemodynamic Integrity of the Implanted TAVR Valve

Careful follow-up of prosthetic valve position, morphology, and function after transcatheter aortic valve replacement (TAVR) is key for early detection and optimal management of complications. The purpose of this chapter is to provide an overview of the current state of knowledge and future perspectives with regard to the role of multimodality imaging in the evaluation of the structural and hemodynamic integrity of the implanted transcatheter heart valve (THV). The goals of post-implant imaging are the following: (1) structural evaluation, including assessment of valve stent deployment and position and of valve cusps morphology and mobility; (2) functional evaluation including measurement of transprosthetic gradients, valve effective orifice area (EOA), and Doppler velocity index, and quantification of valvular an paravalvular regurgitation; and (3) detection of late complications such as migration of the prosthesis, formation of pannus or thrombus, impingement of the mitral valve, perforation of the ventricular septum, and endocarditis.