Guidelines for the Evaluation of Valvular Regurgitation after Percutaneous Valve Repair or Replacement

Date: June 12, 2019

Time: 01:00PM - 02:00PM

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Introduction/Statement of Need:
Hemodynamics of percutaneous valves have been very favorable. However, a challenging area has been the new or residual valve regurgitation that may occur either after transcatheter valve implantation or repair of a native or prosthetic valve. This condition presents a diagnostic and therapeutic challenge to the interventional and imaging cardiology team in the catheterization laboratory and to the clinician and imager in the outpatient setting. The current document addresses the challenges of assessing residual regurgitation after percutaneous valve replacement or repair and provides a guide to the cardiac team on how best to approach this condition, based on the available data and a consensus of a panel of experts.

Target Audience:
This activity is designed for all cardiac sonographers and cardiovascular physicians with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals.

Learning Objectives:
At the end of this article the reader will better be able to:

  • Describe the various echo-Doppler methods for intra-operative monitoring during transcatheter aortic valve replacement and transcatheter mitral valve repair
  • Enumerate the various methods used for evaluation of post-procedure prosthetic valve regurgitation
  • Analyze the relative advantages/disadvantages of echo-Doppler echocardiography in assessing post-procedure valvular regurgitation
  • Summarize the key criteria for diagnosis of mild versus severe post procedure prosthesis regurgitation



The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


The American Society of Echocardiography designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine's (ABIM). Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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William A. Zoghbi, MD, FASE, (Chair), Federico M. Asch, MD, FASE, Charles Bruce, MBChB, FASE, Linda D. Gillam, MD, MPH, FASE, Paul A. Grayburn, MD, FASE, Rebecca T. Hahn, MD, FASE, Ignacio Inglessis, MD, Ashequl M. Islam, MD, MPH, FSCAI, Stamatios Lerakis, MD, FASE, Stephen H. Little, MD, FASE, Robert J. Siegel, MD, FASE, Nikolaos Skubas, MD, DSc, FASE, Timothy C. Slesnick, MD, FASE, William J. Stewart, MD, FASE, Paaladinesh Thavendiranathan, MD, MSc, FASE, Neil J. Weissman, MD, FASE, Satoshi Yasukochi, MD, JCC, SJSUM, and Karen G. Zimmerman, BS, ACS, RDCS, RVT, FASE, Houston and Dallas, Texas; Washington, District of Columbia; Rochester, Minnesota; Morristown, New Jersey; New York, New York; Boston and Springfield, Massachusetts; Los Angeles, California; Cleveland, Ohio; Atlanta, Georgia; Toronto, Ontario, Canada; Nagano, Japan; Morgantown, West Virginia


According to ACCME policy, ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity.

The following authors reported no actual or potential conflicts of interest in relation to this document:
Ignacio Inglessis, MD; Nikolaos Skubas, MD, FASE, DSc; Timothy Slesnick, MD, FASE; William J. Stewart, MD, FASE; Paaladinesh Thavendiranathan, MD; Satoshi Yasukochi, MD, JCC, SJSUM; Karen G. Zimmerman, BS, ACS, RDCS, RVT, FASE

The following authors reported relationships with one or more commercial interests:
Federico M. Asch, MD, FASE and Neil J. Weissman, MD, FASE have been directors of an academic core lab providing services for Edwards Lifesciences, Medtronic, Boston Scientific/Symetis, Abbott/St Jude Medical, Neovasc, Mitralign, GDS, Caisson/Livanova, Biotronik, and DirectFlow. Charles Bruce, MBChB, FASE, consulted for Edwards Lifesciences; Linda D. Gillam, MD, MPH, FASE provided core lab services for Edwards Lifesciences and Medtronic; Paul A. Grayburn, MD, FASE, consulted for Abbott Vascular, Neochord, and Tendyne and received research support from Abbott Vascular, Tendyne, Valtech, Edwards, Medtronic, Neochord, and Boston Scientific; Rebecca T. Hahn, MD, FASE, consulted for Abbott Vascular, Edwards Lifesciences, Medtronic, Philips Healthcare, Siemens Healthineers and Gore and Associates, serves on the speaker’s bureau for Abbott Vascular, Boston Scientific, Edwards Lifesciences, Philips Healthcare, Siemens Healthineers; Ashequl M. Islam, MD, MPH, FSCAI, consulted for Edwards and Medtronic; Stamatios Lerakis, MD, FASE, consulted for Edwards Lifesciences; Stephen H. Little, MD, FASE, received research support from Medtronic and Abbott Vascular, and consulted for Abbott Vascular. Robert J. Siegel, MD, FASE, served on the speaker’s bureau for Abbott Vascular and Philips; William A. Zoghbi, MD, FASE, has a licensing agreement with GE Healthcare and is on the advisory board for Abbott Vascular, GE Healthcare, and Siemens Healthineers.

The following CME reviewers, ASE Staff and JASE editors reported no actual or potential conflicts of interest in relation to this document:
Hedda Richards, MD, FASE, Brandon Stacey, MD, FASE, Elizabeth Lane, and Christina LaFuria

The following CME reviewers, ASE Staff and JASE editors reported relationships with one or more commercial interests:

Method of Participation:

Online Only

Estimated Time to Complete this Activity:

1 hours

Receiving CME Credit:

To receive online CME credit for this activity, complete the full activity then complete the posttest and evaluation. A score of 70% or higher is required for successful completion. You will be able to print your CME certificate immediately following successful completion of the posttest and evaluation.

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This activity is made available by ASE as a courtesy reference source for members. This activity contains recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in this activity are primarily based on the opinions of experts, rather than on scientifically verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the information in this report, including the warranty of merchantability or fitness for a particular purpose. In no event shall ASE be liable to you, your patients, or any other third parties for any decision made or action taken by you or such other parties in reliance on this information. Nor does your use of this information constitute the offering of medical advice by ASE or create any physician patient relationship between ASE and your patients or anyone else.

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