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Valvular Heart Disease 2

This was a very interesting session on valvular heart disease with a large attendance and great interaction.

Prof. William Zoghbi gave a lecture on prosthesis valve dysfunction. He reported the relevance of clinical evaluation together with baseline echo examination at some time after surgery. This is essential for comparison with subsequent examinations, when there is suspicion of dysfunction. The most useful Doppler indices are those incorporating both flow and gradients, like Doppler velocity index. Fluoroscopy, and sometimes CT and even CMR, can be useful complementary techniques in individual cases.

Prof. Alik Sagie reported on paravalvular leak (PVL) and haemodynamic deterioration. He reported that significant PVL occurs after TAVI in up to 20% of cases, and it is associated with worse clinical outcome.PVL jets are often multiple, eccentric and irregular, therefore assessing their severity is challenging. Assessing the severity of PVL demands an integrated approach with multi-window 2D TTE, and sometimes 2D/3D TEE, contrast injections, haemodynamic assessment and dedicated clinical expertise to define in which patient closure of PVL may be mandatory.

Prof. Cetin Erol reported what the recent guidelines tell us regarding the assessment of endocarditis. Immediate access to diagnostic procedures should be available when needed (TTE, TEE, multislice CT, MR and nuclear imaging). Immediate accessibility to cardiac surgery should also be possible as soon as needed. Several specialists with different expertise and an active collaborative network should actively cooperate as an Endocarditis Team on site.

Finally, Prof. Ivan Stankovic reported on right-sided valve disease assessment. Echocardiographic assessment of right sided valves is more challenging, less applicable and less standardized and validated than for left side valves. Subcostal views and approach can be useful in several cases. Congenital multiple heart defects are frequent in this setting and require specific expertise. Multimodality imaging may be needed, but is still not standardized.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.