Three-Dimensional Blood Flow Alterations After Transcatheter Aortic Valve Implantation

We present findings in a 79-year-old man after transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis using a 26-mm Edwards Lifesciences Sapien 9000TFX valve.1 His predicted risk of operative mortality (Society of Thoracic Surgery score) was 12% on the basis of the following comorbidities: 2 previous coronary artery bypass operations, New York Heart Association functional class IV, hypertension, mild lung disease, ejection fraction of 25%, creatinine of 1.2 mg/dL, atrial fibrillation, and peripheral vascular disease. He underwent transapical delivery of the valve on January 5, 2011, without complication. His initial postoperative echocardiogram showed moderate aortic regurgitation (AR), mean gradient of 49mm Hg, and ejection fraction of 25%. After discharge, the patient was reevaluated for recurrent dyspnea.To gain further insight into the systemic implications of AR on hemodynamics of the left ventricular outflow tract in relation to potential congestive heart failure after TAVI, we performed time-resolved 3-dimensional (3D) magnetic resonance velocity mapping (4-dimensional [4D] flow magnetic resonance imaging [MRI])2 6 months postoperatively. The study was approved by the institutional review board, and informed consent was obtained from the patient. Magnetic resonance imaging examination (1.5T Espree, Siemens, Germany) included 4D flow (velocity sensitivity=150 cm/s, spatial/temporal resolution=2.5×2.1×3.2 mm3/42 ms) and dynamic 2D cine imaging of the heart (steady-state free precession, spatial/temporal resolution=1.4×1.6×8 mm3/49 ms).Echocardiographic assessment of aortic insufficiency was performed using standard parasternal and apical views with …