Pitfalls and solutions in the imaging follow-up of valvular heart disease devices

Doppler-echocardiography is the primary imaging modality for the evaluation and follow-up of valvular heart devices. This article highlights the unique pitfalls associated with these devices, including imaging challenges and flow dynamics, which often push echocardiography to its limits. The use of a multi-modality imaging approach including cardiac computed tomography (CT) and magnetic resonance, and positron emission tomography-CT is recommended to confirm the diagnosis of prosthetic valve dysfunction (PVD), quantify its severity and determine its mechanism and aetiology. Thus, the distinction between non-structural and structural PVD is important to make by assessing: (i) the morphology and mobility of the valve leaflets; (ii) the changes in valve haemodynamic parameters during echocardiographic follow-up. Algorithms are also proposed to assess the presence and severity of residual valve regurgitation and iatrogenic stenosis following mitral or tricuspid transcatheter edge-to-edge repair. This article aims to enhance the understanding of imaging challenges and to propose solutions for clinicians managing patients with valvular heart disease devices.