Bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have... Show moreBioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have limited durability because of structural valve deterioration. The main objective of this summary of experts participating in a virtual workshop was to propose standardized definitions for nonstructural and structural BVD and BVF following aortic or mitral biological valve replacement with the goal of facilitating research reporting and implementation of these terms in clinical practice. Definitions of structural BVF, based on valve reintervention or death, underestimate the true incidence of BVF. However, definitions solely based on the presence of high transprosthetic gradient at a given echocardiogram during follow-up overestimate the incidence of structural BVD and BVF. Definitions of aortic or mitral structural BVD must therefore include the confirmation by imaging of permanent structural changes to the leaflets alongside evidence of deterioration in valve hemodynamic function at echocardiography follow-up. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. Show less
Up to 40% of patients with aortic stenosis (AS) present with a "discordant grading" usually referred to as "low-gradient AS." This article presents a step-by-step integrative approach overview of... Show moreUp to 40% of patients with aortic stenosis (AS) present with a "discordant grading" usually referred to as "low-gradient AS." This article presents a step-by-step integrative approach overview of the utility, limitations, and complementary role of the different imaging modalities for the assessment of AS severity with a special emphasis on the reconciliation of discordant grading. The first step is to confirm the validity of echocardiographic measures of AS severity. For example, hybrid imaging can combine left ventricular outflow tract area measured by 3-dimensional echocardiography or contrast enhanced multidetector row computed tomography with flow velocities measured by Doppler. The next step is to differentiate severe from non-severe AS with the use of low-dose dobutamine stress echocardiography, especially in patients with low left ventricular ejection fraction, low-flow, low-gradient AS. Aortic valve calcium scoring measured by noncontrast multidetector row computed tomography is preferred in patients with low-gradient AS and preserved left ventricular ejection fraction as well as in those with inconclusive results with dobutamine stress echocardiography. (c) 2019 by the American College of Cardiology Foundation. Show less
