Trivial pericardial effusion serial#
Since 2007 there has been serial reduction in the entry profile of delivery devices for THVs such that a greater proportion of patients are suitable for transfemoral procedures. However, TOE carries a risk of oesophageal injury and increases procedure times. Intraprocedural transoesophageal echocardiographic guidance was the norm. In the early years of TAVI, due to the large profile of the delivery catheters employed, particularly with balloon-expandable technologies, procedures were undertaken with general anaesthesia with surgical cut down for femoral access. TAVI has become the treatment of choice in patients considered inoperable and at high operative risk and is increasingly used in patients at intermediate and low risk, supported by guidelines.
The first Transcatheter Aortic Valve Implantation (TAVI) procedure was performed in man in 2002 and transcatheter heart valves (THV) became commercially available in Europe in 2007 and in North America in 2011. TOE guidance may also be preferable in patients with severe renal insufficiency, particularly in conjunction with fusion imaging, to minimize contrast use and the consequent risk of renal injury.Īortic stenosis is the most prevalent valvular lesion in Europe and North America. In the modern era of minimalist TAVI with transfemoral access and conscious sedation, transoesophageal echocardiography (TOE) may be preferable in a small proportion of TAVI procedures undertaken with general anaesthesia, with the benefit of continuous echocardiographic monitoring and reduced risk of contamination of the sterile field. This protocol provides guidance on which key assessments are required, important pitfalls and provides examples of important complications that may arise in order to allow timely identification and effective management. We propose a time-efficient, focused protocol for echocardiographers to follow when echocardiography is used to guide transfemoral TAVI undertaken with conscious sedation. Transthoracic echocardiography (TTE) is the main form of imaging employed in these procedures and is used to detect complications, assess the result of transcatheter heart valve (THV) implantation and guide further management. Transfemoral transcatheter aortic valve implantation (TAVI) undertaken with conscious sedation, rather than with general anaesthesia, is the most widely practised mode of implantation in Europe.
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