Aims: Videodensitometric assessment of aortography provides a periprocedural quantitation of prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation. We sought to compare the videodensitometric parameters of PVR severity to the regurgitation fraction (RF) in a controlled in vitro setting.
Methods and results: In a mock circulation system, a transcatheter balloon-expandable valve inserted at the aortic valve position was gradually deformed to induce different grades of paravalvular leakage and the RF was measured with a transonic flow probe. Contrast aortography was performed and the following videodensitometric parameters were generated: left ventricle aortic regurgitation (LV-AR), LV outflow tract AR (LVOT-AR), quantitative regurgitation assessment (qRA) index, relative maximum density (relative max), and maximum upslope of the LV time-density curve. The correlation was substantial between videodensitometric parameters and RF. LV-AR and LVOT-AR were not different and were strongly correlated with a mean difference of 1.92%. The correlations of LV-AR and LVOT-AR with RF were stronger when more than one cardiac cycle was included in the analysis. Including more cycles beyond four did not improve accuracy.
Conclusions: Quantitative assessment of PVR by videodensitometry of aortograms strongly correlates with the actual RF in a controlled in vitro setting. Accuracy is improved by including more than one cardiac cycle in the analysis.

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Abdelghani, M, Miyazaki, Y, De Boer, E.S. (Ellen S.), Aben, J.P.M.M, Van Sloun, M. (Math), Suchecki, T. (Todd), … Serruys, P.W.J.C. (2018). Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: In vitro validation. EuroIntervention, 13(13), 1527–1535. doi:10.4244/EIJ-D-17-00595