Our Summary

This research paper discusses the importance of using multiple types of heart imaging before, during, and after a procedure known as transcatheter aortic valve replacement (TAVR). This procedure is used for patients with a severe heart condition called aortic stenosis. The paper emphasizes the need for careful planning before the procedure, using different imaging techniques, to minimize any potential complications. It also highlights the importance of quickly assessing the new valve’s function during or right after the procedure using echocardiography (a type of ultrasound for the heart). After the procedure, various imaging methods are used to evaluate the function of the new valve and manage any complications. The paper suggests that a combination of these imaging techniques can be very helpful in predicting, detecting, and handling any issues that may arise after TAVR.

FAQs

  1. What is the role of multimodal cardiac imaging in the management of patients with valvular heart disease?
  2. How is multimodal imaging used in the pre-procedural planning for transcatheter aortic valve replacement (TAVR)?
  3. What are the uses of echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in the post-procedural evaluation of TAVR?

Doctor’s Tip

One helpful tip a doctor might tell a patient about valve replacement is to make sure to attend all follow-up appointments and communicate any new symptoms or concerns promptly. This will help the doctor monitor the function of the new valve and address any complications early on. Additionally, it is important to follow any lifestyle changes or medication regimens prescribed by the doctor to ensure the best possible outcome after valve replacement surgery.

Suitable For

Patients who are typically recommended valve replacement include those with severe valvular heart disease, such as severe aortic stenosis, mitral regurgitation, or tricuspid regurgitation. These patients may be symptomatic with symptoms such as chest pain, shortness of breath, fatigue, or heart palpitations. They may also have evidence of significant valve dysfunction on imaging studies, such as echocardiography, cardiac computed tomography, or cardiac magnetic resonance imaging. Patients who are considered high-risk for traditional open-heart surgery may also be candidates for valve replacement, particularly transcatheter aortic valve replacement (TAVR). Careful pre-procedural planning and post-procedural monitoring with multimodal cardiac imaging are essential for successful outcomes in these patients.

Timeline

Before valve replacement:

  • Patient presents with symptoms of valvular heart disease, such as shortness of breath, chest pain, fatigue, and dizziness.
  • Patient undergoes various diagnostic tests, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging to assess the severity of the valve disease and determine the best treatment approach.
  • After careful evaluation, the patient is deemed a candidate for valve replacement, either through traditional open-heart surgery or transcatheter aortic valve replacement (TAVR).

After valve replacement:

  • Patient undergoes the valve replacement procedure, either through open-heart surgery or TAVR.
  • Immediate post-procedural echocardiography is performed to assess the function of the new valve and evaluate for any complications.
  • Patient is monitored closely in the hospital for any signs of complications, such as paravalvular leak or structural issues with the new valve.
  • Follow-up imaging studies, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, may be scheduled to monitor the long-term function and durability of the new valve.
  • Patient undergoes cardiac rehabilitation and is advised on lifestyle changes and medications to manage their heart condition and prevent future complications.

What to Ask Your Doctor

  1. What type of valve replacement procedure is recommended for me (transcatheter aortic valve replacement, surgical valve replacement, etc.)?
  2. What are the potential risks and complications associated with valve replacement surgery?
  3. How long is the recovery time after valve replacement surgery?
  4. Will I need to take any medication after the procedure? If so, what are the potential side effects?
  5. How often will I need follow-up appointments and tests after the valve replacement surgery?
  6. What lifestyle changes will I need to make after the procedure?
  7. What are the signs and symptoms of complications that I should watch for after the procedure?
  8. How long can I expect the new valve to last before needing to be replaced again?
  9. Are there any restrictions on physical activity or diet that I should be aware of after the procedure?
  10. Are there any support groups or resources available for patients who have undergone valve replacement surgery?

Reference

Authors: Corrigan FE 3rd, Gleason PT, Condado JF, Lisko JC, Chen JH, Kamioka N, Keegan P, Howell S, Clements SD Jr, Babaliaros VC, Lerakis S. Journal: JACC Cardiovasc Imaging. 2019 May;12(5):904-920. doi: 10.1016/j.jcmg.2018.07.036. PMID: 31072518