PMID- 24585552
OWN - NLM
STAT- MEDLINE
DCOM- 20151204
LR  - 20161125
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 47
IP  - 1
DP  - 2015 Jan
TI  - Contrast echocardiography: a novel technique for assessment of total aortic 
      regurgitation following transapical aortic valve implantation.
PG  - 18-23
LID - 10.1093/ejcts/ezu065 [doi]
AB  - OBJECTIVES: Aortic regurgitation (AR) is a possible complication following 
      transcatheter aortic valve implantation (TAVI) which is associated with 
      less-favourable outcomes. Quantification of total regurgitation caused by 
      multiple, multidirectional jets remains controversial. The purpose of this study 
      was to assess the usefulness of retrograde contrast echocardiography in 
      quantification of total AR following TAVI and to evaluate its prognostic 
      significance. METHODS: In 245 patients following Edwards Sapien valve (Edwards 
      Lifesciences, Irvine, CA, USA) implantation, we performed retrograde contrast 
      transoesophageal echocardiography to quantify AR immediately after TAVI. The 
      contrast (20 ml agitated gelatine polysuccinate, Gelafundin 4%, Braun, Melsungen, 
      Germany) was injected as a bolus into the sinotubular junction of the aorta 
      through a pigtail catheter. We measured the area of the regurgitant cloud during 
      mid- to end-diastole. A regurgitant area of >/=3.8 cm2 was determined as an 
      indicator of relevant AR. Sensitivity of this was compared through angiography 
      and Doppler echocardiography. To assess whether AR identified by this novel 
      method independently determined survival, a multivariate model was applied. 
      RESULTS: Angiography, Doppler echocardiography and contrast echocardiography 
      recognized 15, 23 and 56 patients with relevant regurgitation. Multivariate 
      analysis including a regurgitant area of >/=3.8 cm2, New York Heart Association 
      (NYHA) class IV, age and creatinine concentration identified a regurgitant area 
      of >/=3.8 cm2 (P=0.027) as independent risk factor for 2-year survival. 
      CONCLUSIONS: Contrast echocardiography is a simple method for quantification of 
      total AR following TAVI and is more sensitive than angiography or Doppler 
      echocardiography. Its clinical relevance is demonstrated by the impact of the AR 
      detected by contrast echocardiography on survival.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Kukucka, Marian
AU  - Kukucka M
AD  - Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany 
      kukucka@dhzb.de.
FAU - Pasic, Miralem
AU  - Pasic M
AD  - Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, 
      Berlin, Germany.
FAU - Habazettl, Helmut
AU  - Habazettl H
AD  - Institute of Physiology, Charite, Berlin, Germany.
FAU - Unbehaun, Axel
AU  - Unbehaun A
AD  - Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, 
      Berlin, Germany.
FAU - Dreysse, Stephan
AU  - Dreysse S
AD  - Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
FAU - Drews, Thorsten
AU  - Drews T
AD  - Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, 
      Berlin, Germany.
FAU - Hillebrandt, Thorsten
AU  - Hillebrandt T
AD  - Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
FAU - Mladenow, Alexander
AU  - Mladenow A
AD  - Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
FAU - Buz, Semih
AU  - Buz S
AD  - Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, 
      Berlin, Germany.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20140228
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Contrast Media)
SB  - IM
MH  - Aged, 80 and over
MH  - Aortic Valve/diagnostic imaging/*surgery
MH  - Aortic Valve Insufficiency/diagnosis/*diagnostic imaging/etiology/mortality
MH  - Contrast Media
MH  - Echocardiography/*methods
MH  - Echocardiography, Doppler, Color/methods
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*adverse effects/methods/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Prognosis
OTO - NOTNLM
OT  - Aortic regurgitation
OT  - Contrast echocardiography
OT  - Survival
OT  - Transcatheter aortic valve implantation
EDAT- 2014/03/04 06:00
MHDA- 2015/12/15 06:00
CRDT- 2014/03/04 06:00
PHST- 2014/03/04 06:00 [entrez]
PHST- 2014/03/04 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - ezu065 [pii]
AID - 10.1093/ejcts/ezu065 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2015 Jan;47(1):18-23. doi: 10.1093/ejcts/ezu065. Epub 
      2014 Feb 28.