AUTHOR=Abdelshafy Mahmoud , Serruys Patrick W. , Tsai Tsung-Ying , Revaiah Pruthvi Chenniganahosahalli , Garg Scot , Aben Jean-Paul , Schultz Carl J. , Abdelghani Mohammad , Tonino Pim A. L. , Miyazaki Yosuke , Rutten Marcel C. M. , Cox Martijn , Sahyoun Cherif , Teng Justin , Tateishi Hiroki , Abdel-Wahab Mohamed , Piazza Nicolo , Pighi Michele , Modolo Rodrigo , van Mourik Martijn , Wykrzykowska Joanna , de Winter Robbert J. , Lemos Pedro A. , de Brito Fábio S. , Kawashima Hideyuki , Søndergaard Lars , Rosseel Liesbeth , Wang Rutao , Gao Chao , Tao Ling , Rück Andreas , Kim Won-Keun , Royen Niels van , Terkelsen Christian J. , Nissen Henrik , Adam Matti , Rudolph Tanja K. , Wienemann Hendrik , Torii Ryo , Josef Neuman Franz , Schoechlin Simon , Chen Mao , Elkoumy Ahmed , Elzomor Hesham , Amat-Santos Ignacio J. , Mylotte Darren , Soliman Osama , Onuma Yoshinobu TITLE=Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1161779 DOI=10.3389/fcvm.2023.1161779 ISSN=2297-055X ABSTRACT=

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.