Author + information
- Received July 19, 2016
- Revision received August 4, 2016
- Accepted August 12, 2016
- Published online January 2, 2017.
- Leo Marcoff, MDa,∗ (, )
- Konstantinos P. Koulogiannis, MDa,
- Lillian Aldaia, MDa,
- David P. Fuschetto, MDb,
- Robert M. Kipperman, MDa,
- Saaron Laighold, MDb and
- Linda D. Gillam, MDa
- aDepartment of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey
- bDepartment of Cardiology, North Shore University Hospital/Northwell Health, Manhasset, New York
- ↵∗Reprint requests and correspondence:
Dr. Leo Marcoff, Morristown Medical Center, 100 Madison Avenue, Gagnon C, Morristown, New Jersey, 07960.
Previous reports have identified the role of transthoracic echocardiography (TTE) in detecting subclinical transcatheter heart valve (THV) thrombosis as limited to monitoring transvalvular gradients, because leaflet hypomobility or thrombus are usually seen only on transesophageal echocardiography (TEE) and cardiac computed tomography (CT) (1,2). In this imaging vignette, we illustrate the concept of paucity of color Doppler flow within a region of the valve stent as an indicator of leaflet restriction and probable thrombosis. We present 4 confirmed cases of THV thrombosis (Figures 1, 2, 3, and 4, Online Videos 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, and 17), involving self-expanding and balloon-expandable valves in the aortic and mitral positions. In the absence of artifacts (reverberations, shadowing, foreshortening), color paucity has the potential to increase TTE’s sensitivity for THV leaflet dysfunction by being incremental to elevated gradients and suspected leaflet hypomobility. Occasionally, color paucity may be the only clue to underlying thrombosis, because gradients are not always significantly elevated, especially if a single cusp is involved.
For supplemental videos, please see the online version of this article.
Dr. Kipperman has been a proctor for Medtronic. Dr. Gillam is the director of core laboratories with contracts with Edwards Lifesciences and Medtronic, for which she receives no direct compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 19, 2016.
- Revision received August 4, 2016.
- Accepted August 12, 2016.
- American College of Cardiology Foundation
- Mack M.J.,
- Douglas P.S.,
- Holmes D.R.