1. Philippe Pibarot et al. JIMG 2015;8:340-360
Online Video 19 Representative images of the different classes of severity according to the 7-class grading scheme (Table 1). The videos #13 to 36 show the PSAX, PLAX, AP5, and AP3 color Doppler TTE views for each patient. Below are presented the PVR severity grade in the 7-class scheme (with the corresponding grading in the 3-class scheme) as well as the main the criteria that were used to determine the severity class of PVR. Patient #5 (see Videos # 13-16): Trace PVR (i.e. trace in 3-class scheme). Criteria: jet width at its origin and jet circumferential extent (<10%). There is one small jet located at 3 o’clock in the PSAX view. Patient #6 (see Videos # 17-20): Mild PVR (i.e. mild in 3-class scheme). Criteria: width of the jets at their origin. There are 2 small jets, one anterior (1-2 o’clock in the PSAX view) and one posterior. The posterior jet is not visualized in the PSAX and PLAX views most likely due to shadowing phenomenon but it is clearly visible in the AP5 view. The circumferential extent of the anterior jet may be overestimated due to the eccentric nature of this jet and to the fact that the imaging plane is not exactly at the level of the vena contracta. Patient #7 (see Videos # 21-24): mild-to-moderate PVR (i.e. mild in 3-class scheme). Criteria: width of the anterior jet at its origin, 2 jets, circumferential extent (20%). There are 2 anterior jets (2 and 11 o’clock in the PSAX view). One of the anterior jet is very eccentric has a larger origin width. There is a small posterior jet visible in the AP3 view. There is also a trace central AR visible in the AP5 and AP3 views. Patient #8 (see Videos # 25-28): moderate PVR (i.e. moderate in 3-class scheme). Criteria: width of the anterior jet at its origin, 2 jets, circumferential extent (27%), jet path visible. There are 2 jets: one anterior (1-3 o’clock in the PSAX view) with moderately large origin width in the PLAX and Ap5 views and one lateral jet only visible in the PSAX view (7-8 o’clock). The path of the anterior jet is visible in the PLAX view. There is also a mild central AR visible in AP5 and AP3 views. Patient #9 (see Videos # 29-32): moderate PVR (i.e. moderate in 3-class scheme). Criteria: width of the anterior jet at its origin, several jets, circumferential extent (23%), jet path visible. There are several contiguous anterior jets (in the 1-4 o’clock section in the PSAX view) with one jet having moderately large origin width in the PLAX and Ap5 views. The jets are not well visualized in the AP3 view. Patient #10 (seeVideos # 33-36): moderate-to-severe PVR (i.e. moderate in 3-class scheme). Criteria: width of the jets at their origin, 2 major jets, jet path visible along the stent, abnormal shape of the stent. There is an important anterior jet that has a large origin in the PSAX, PLAX, AP5, and AP3 views. This is an example where the jet circumferential extent (17%) assessed in the PSAX view would markedly underestimate the severity of PVR. Indeed, the anterior jet does not occupy a large portion of the stent circumference but the width of its vena contract is large. Furthermore, the posterior jet, which also has a large origin width in the AP5 and AP3 views, is not visualized in the PSAX view, which contributes to the underestimation of PVR extent. The anterior jet is located in regard of an important deformation of the THV stent. The path of the jet along the stent is visible in the AP5 view for the posterior jet.
Philippe Pibarot et al. JIMG 2015;8:
American College of Cardiology Foundation