Cardiac Magnetic Resonance for Paravalvular Leaks in Post-Transcatheter Aortic Valve Replacement

An 80-year–old man with known coronary artery disease presented with progressively worsening shortness of breath over the past few weeks. On transthoracic echocardiography (TTE) examination he was found to have severe aortic stenosis with an aortic valve area of 0.8 cm2. Maximum aortic valve velocity was 4.25 m/s, peak gradient was 72.2 mm Hg with a mean gradient of 43.0 mm Hg, and mild aortic valve insufficiency was noted. He was deemed a surgical candidate and was randomly assigned to transcatheter aortic valve replacement (TAVR) as part of the Placement of Aortic Transcatheter Valve Trial II trial. An Edwards Sapien 29-mm XT bioprosthetic valve was placed through left-sided transfemoral access uneventfully. Within a day of the procedure, the patient reported worsening dyspnea. A postprocedural TTE revealed mild anterior and posterior paravalvular leak (PVL) by color Doppler (Figure 1 and Movie I in the online-only Data Supplement). Given the clinical and imaging findings, a higher-grade PVL was suspected, prompting further evaluation with cardiac magnetic resonance (CMR) imaging.Figure 1. Post-transcatheter aortic valve replacement transthoracic echocardiogram showing paravalvular defect and leak. A , B-mode parasternal long axis view showing 29-mm Sapien valve in the aortic position (yellow arrows). B …