Validación del cálculo del orificio regurgitante efectivo mediante planimetría sobre imágenes 3D-color de ecocardiografía transesofágica en el diagnóstico y pronóstico de pacientes con "leaks" perivalvulares mitrales

Abstract

Las dehiscencias o “leaks” perivalvulares (LPV) son comunicaciones anómalas entre cavidades cardiacas adyacentes, o entre éstas y los grandes vasos, que se forman a través del tejido circundante a una válvula protésica (1), de manera inmediata o diferida tras su implante (figura 1). Así pues, un LPV no es sino una de las complicaciones que pueden aparecer tras el implante de una prótesis valvular, y su repercusión funcional lógica es la aparición de regurgitación valvular de tipo perivalvular (RPV) con un mayor o menor grado de hemólisis asociada, con el deterioro clínico y pronóstico que ello puede implicar para los pacientes...

Paravalvular leaks (PVL) are a common complication after mitral valve replacement surgery. Three-dimensional (3D) transesophageal echocardiography (TEE) has emerged as the preferred imaging modality to evaluate the morphology and extent of these leaks, as it better demonstrates, compared with two-dimensional (2D) echocardiography, the shapes and sizes of the leaks. 3D-TEE is also the recommended technique to guide transcatheter PVL closure procedures. However, severity assessment of paravalvular regurgitation (PVR) caused by PVL using 3D-TEE is technically difficult. Common measurements of mitral regurgitation severity, such as jet width (vena contracta) and jet area on color-flow imaging, are useful in this context, but other parameters, such the proximal isovelocity surface area radius, have not been validated. PVL sizing can be performed by 3D transesophageal echocardiographic planimetry without using color-flow images, by measuring the areas of echo dropout that represent the presence of a leak. This method actually measures the anatomic regurgitant orifice (ARO) size rather than the effective regurgitant orifice (ERO). Moreover, it may overestimate or underestimate the sizes of PVL, as the extension of these anechoic areas depends on parameters such as the gain and compression values used for the acquisition of images, and resolution may be limited. Three-dimensional transesophageal echocardiographic planimetry using color-flow images may improve PVL sizing, as it enables accurate planimetry of the ERO of the leaks. This novel method may be useful to quantify PVR and to assess or predict percutaneous PVL closure success...