TEE is Essential During TAVR E Murat Tuzcu

TEE is Essential During. TAVR E Murat Tuzcu, MD Professor of Medicine Vice-chairman Department of Cardiovascular Medicine Cleveland Clinic Financial disclosures: None

TEE is Essential during TAVR Pre-procedural assessment Intra-procedural guidance Intra and post procedural assessment

TEE is Essential during TAVR Pre-procedural assessment Intra-procedural guidance Intra and post procedural assessment

Pre-procedural Echo Assessment 3 D Long Axis 3 D short Axis

Pre-procedural Echo Assessment • Severe aortic arch atheroma • Seen by CT but better defined by TEE

TEE is Essential during TAVR Pre-procedural assessment Intra-procedural guidance Intra and post procedural assessment

Accurate positioning of the prosthesis is done by fluoroscopy/angiography Echocardiography is a secondary adjunctive imaging modality

TEE is Essential during TAVR Intra and post Intra-procedural guidance procedural assessment Pre-procedural assessment

• Mitral valve at TEE before TAVR - No structural abnormality - Moderate MR

• Aortic valve at TEE before TAVR - Severe AS - No AR Calc AVA = 0. 7 cm 2

Severe AR: note short pressure half time and AR density as dense as antegrade flow.

Is the AR intra-prosthetic or para-prosthetic?

Are the leaflets moving appropriately?

Globally depressed LV function

New Severe MR

TEE is Essential during TAVR 18

Anterior, Septal, Lateral WMA

Post-deployment Angiography

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TEE is Essential during TAVR Pre- valve deployment Immediately after valve deployment Patient is stable

Repeat TEE

TEE is Essential during TAVR

Post-deployment Angiography

TEE is Essential during TAVR. Because: • TEE provides immediate differential diagnoses for severe refractory hypotension and saves the precious first few minutes for prompt lifesaving treatment. – Severe AR – LV dysfunction – Severe MR – Coronary occlusion – Pericardial effusion – Major bleeding – Severe LVH, small cavity