主动脉瓣狭窄和主动脉瓣反流患者的主动脉解剖学比较

目的通过多排计算机断层成像(multi-detector computed tomography,MDCT)和超声心动图,比较严重主动脉瓣狭窄(aortic stenosis,AS)和主动脉瓣反流(aortic regurgitation,AR)患者主动脉根部解剖特征,为AR新型器械设计和经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的治疗提供参考。方法纳入2014年4月至2016年5月连续入组就诊于上海复旦大学附属中山医院,患有严重AS或AR并计划接受TAVR治疗的患者共170例,其中包括AR组57例,AS组113例。所有患者均接受MDCT和超声心动图检查,并对测量数据进行分析。结果AR组患者平均主动脉瓣环直径[(26.4±3.7)mm比(25.2±2.9)mm,P=0.001]、平均升主动脉直径[(38.3±6.9)mm比(33.9±6.7)mm,P0.001]和主动脉窦直径[(38.9±6.9)mm比(32.7±4.5)mm,P0.001]均大于AS组患者,差异均有统计学意义。两组患者左冠状动脉开口高度比较,差异无统计学意义(P=0.080);AR组患者右冠状动脉开口高度[(17.5±5.0)mm比(15.3±3.3)mm,P=0.010]高于AS组患者,差异有统计学意义。结论 AS和AR患者主动脉解剖学比较结果可为AR新型器械设计和TAVR治疗提供有价值的信息参考。     

15例拟行经导管主动脉瓣置换术患者主动脉根部影像学与临床应用--单中心早期经验

目的：15例拟行经导管主动脉瓣置换术（TAVI）患者主动脉根部影像学与临床应用的单中心早期临床经验。
　　方法：入选我院2011-03至2013-11拟行TAVI的主动脉瓣重度狭窄患者15例,分别进行计算机断层摄影术（CT）扫描、经胸超声心动图采集主动脉根部解剖数据,并对比主动脉瓣环测量差异。根据CT测量结果选择植入瓣膜型号,通过术后6个月随访,评估术前测量准确性。
　　结果：15例患者术前CT测量主动脉瓣环短径（21.5±2.4）mm,主动脉瓣环长径（27.3±2.7）mm,瓣环平均内径（24.4±2.4）mm,左心室流出道长径（28.3±4.5）mm,左心室流出道平均内经（24.±3.5）mm;升主动脉内径（35.3±4.4） mm。置入A-Venus人工瓣膜26号瓣膜8例,29号瓣膜7例。CT测量主动脉瓣环内径均值大于经胸超声心动图主动脉瓣环内径均值,差异有统计学意义（P<0.001）。经6个月随访,15例患者均未出现主动脉根部破裂、阻挡冠状动脉、主动脉瓣及瓣周中量及以上反流,有4例患者因房室传导阻滞行永久起搏器置入。
　　结论：CT及经胸超声心动图对于主动脉瓣环测量结果存在差异,CT测量可准确有效评估主动脉根部形态及毗邻,为TAVI提供有力支持。     

经导管主动脉瓣置换术后新发传导阻滞的危险因素分析及预测

目的 探究经导管主动脉瓣置换术（TAVR）后新发传导阻滞（NOCD）的相关因素,建立预测模型对传导阻滞发生风险进行评估。方法 纳入2016年1月至2022年3月中南大学湘雅二医院行TAVR的症状性重度主动脉瓣狭窄或重度主动脉瓣反流的184例患者,通过医院信息系统和影像数据库收集患者的人口学、病史、检查结果、影像图像等临床数据,测量人工瓣膜置入深度等传导阻滞相关数据,由专科医师对心电图、超声心动图、CT血管造影（CTA）、手术资料等进行数据的提取和分析。使用SPSS软件对数据进行统计学分析,构建NOCD的多因素Logistic回归预测模型。结果 以TAVR术后NOCD作为结局事件,184例患者分为NOCD组（57例）和非NOCD组（127例）。TAVR术后NOCD发生率为31.0%,单纯重度主动脉瓣反流患者TAVR术后NOCD发生率为63.6%(7/11)。NOCD组较非NOCD组的主动脉角度更大[（57.7±10.3）°比（52.0±9.0）°,P<0.001]、锚定区尺寸比更大[（129±28）%比（120±21）%,P=0.018]、人工瓣膜置入位置更深[（7.2±5.1）m...     

经导管人工主动脉瓣植入动物的实验方法及影像分析

目的:建立经导管人工主动脉瓣植入的动物实验方法,确定主动脉窦部造影的最佳投射体位,探讨经腹主动脉植入人工主动脉瓣的可行性、安全性。方法: 选取健康杂种大白猪10只,经右侧股动脉送入猪尾巴导管行左心室造影,确定主动脉窦部造影的最佳投射体位,测量主动脉窦部的直径;经右侧股静脉送入临时起搏电极至右心室,选择合适的起搏频率;经腹主动脉送入22F输送鞘管,观察经输送鞘管推送预载瓣膜支架球囊的可行性、安全性。结果: 左心室造影可在左前斜(30±2)°、头位(10±4)°清楚地显示主动脉窦部及冠脉开口。主动脉窦部的直径为（212±23） mm。实验动物可以耐受连续30 s的快速起搏（240~260次/min）。结论: 经腹主动脉途径植入人工主动脉瓣的方法可行、安全。在左前斜(30±2)°、头位(10±4)°可清楚地显示主动脉窦部。以240~260次/min的频率快速起搏可最大限度地减少血流对球囊的冲击,更好地实现瓣膜植入时的精确定位。     

一种穿刺置管新方法在ECMO联合IABP介入治疗复杂高危冠心病中的应用

目的 评估应用同侧股动脉置入主动脉内球囊反搏（IABP）和大直径经皮冠状动脉介入（PCI）治疗指引导管,联合对侧股动脉与股静脉用于置入体外膜肺氧合（ECMO）的穿刺策略,观察该置管方式对于复杂高危冠心病患者（CHIP）完成PCI手术的安全性和可行性。 方法 共纳入7例患者,左侧股动脉与股静脉置入ECMO鞘管（动脉置管直径15F,静脉置管直径17F）,右侧股浅动脉置入IABP（均为7F动脉鞘管）,右侧股总动脉置入PCI股动脉鞘管（均为7F动脉鞘管）,ECMO动脉及静脉穿刺处采用预置ProGlide血管缝合器止血,PCI和IABP股动脉穿刺处应用Angioseal血管封堵器止血。术后针对股动脉、股静脉穿刺部位进行临床症状与体征评估,并全部进行血管超声检查,观察该穿刺置管的成功率以及完成PCI手术的可行性,观察住院期间穿刺部位相关的并发症发生率。 结果 7例患者中,男性6例,女性1例,年龄（57±12）岁,合并高血压5例（71%）、糖尿病3例（43%）、慢性肾病1例（14%）、高脂血症4例（57%）、卒中1例（14%）、外周血管疾病4例（57%）。双侧股动脉,左侧股静脉穿刺成功率100%,PCI手术完成率100%。仅一例患者术后超声检查发现股浅动脉穿刺部位发生皮下小血肿,所有患者住院期间均未观察到严重血管并发症。 结论 在CHIP患者中,当需要ECMO联合IABP维持血流动力学稳定,并需要穿刺股动脉置入大直径指引导管完成复杂PCI手术的情况下,可采用同侧股浅动脉置入IABP,股总动脉置入大直径（7F）PCI动脉鞘管,对侧股动脉、股静脉置入ECMO的手术穿刺策略,该方法安全可行。     

主动脉根包裹手术治疗主动脉根部动脉瘤

目的:开发一个相对简单有效、手术风险较小的主动脉根部包裹术,以治疗主动脉根动脉瘤。方法:自2008年6月至2014年12月,25例主动脉根部瘤患者接受主动脉根部包裹术,其中合并主动脉瓣狭窄和/或反流者23例。主动脉瓣环的直径22~32mm,平均(26.30±3.45)mm,主动脉窦的直径45~62mm,平均(52.23±6.87)mm。所有患者进行主动脉根部包裹术,同时合并主动脉瓣成形术或置换术23例。结果:25例围手术期无死亡。CBP时间为55~128min,平均(81.56±15.43)min。出院前超声心动图检查结果显示:5例主动脉瓣轻度反流,20例主动脉瓣功能正常,与术前超声心动图结果对比,术后主动脉环直径21~25mm,平均(22.43±1.35)mm,较术前显著减小(P0.01),主动脉窦直径30~52mm,平均(40.56±4.21)mm,显著减小(P0.001)。随访结果:所有25例患者生存良好,心脏功能(NYHA)均恢复I级,近中期无死亡病例。结论:主动脉根部包裹术结合主动脉瓣成型或置换术是一种外科手术治疗主动脉窦动脉瘤和主动脉瓣疾病新方法。     

应用新型介入瓣膜行经导管主动脉瓣置入术的实验研究

目的 探讨应用新型介入瓣膜在实验动物体内行经导管主动脉瓣置入术(TAVI)的可行性,并观察新型介入瓣膜置入后的短期效果.方法 选取健康成年绵羊20只,在全身麻醉及成像造影设备的辅助下,经绵羊一侧颈总动脉置入输送鞘管,于主动脉瓣环处释放新型介入瓣膜.以左心室和主动脉造影及经胸超声心动图观察介入瓣膜的位置和作用.记录术后30 d实验动物的存活情况.结果 所有实验绵羊均置入新型介入瓣膜.15只(75％)存活绵羊的术后造影显示介入瓣膜位置良好,无移位,未影响二尖瓣;冠状动脉开口显影良好,冠状动脉通畅.经胸超声心动图显示5例绵羊存在轻度瓣周漏.术后存活绵羊主动脉瓣反流百分比由术前( 1.25±0.46)％增加至(4.52±3.56)％(P＜0.05).术后主动脉瓣有效瓣口面积、主动脉收缩压、主动脉舒张压、平均主动脉压、左心室收缩压、左心室舒张末压、心率与术前比较差异均无统计学意义(P＞0.05).5只(25％)绵羊于TAVI后30 d内死亡,其中介入瓣膜释放展开后即刻,因左冠状动脉开口堵塞发生心室颤动而死亡1只,术后20 min死于急性心肌梗死1只,术后8和12h死于二尖瓣反流2只,术后26 d死于感染性心内膜炎1只.结论 采用新型介入瓣膜在实验动物体内行TAVI是可行的,短期内安全、有效.     

多层螺旋CT与超声心动图在主动脉根部形态中的应用

目的探讨多层螺旋CT(MSCT)与超声心动图在主动脉根部及邻近组织结构检测中的应用及其临床意义。方法 57例无明显主动脉瓣膜疾病、左室流出道病变患者行CT及超声心动图检查,并测量相关数据。结果 CT测量主动脉根部直径(23.40±3.03)mm,主动脉窦间距(33.65±3.87)mm,冠脉开口处直径(30.19±3.24)mm,升主动脉直径(31.23±4.19)mm。超声心动图测量主动脉根部内径(22.17±2.18)mm,升主动脉内径(29.73±3.68)mm,左室舒张末内径(43.23±3.19)mm,左室收缩末内径(29.19±2.97)mm。结论超声心动图与MSCT可良好显示主动脉根部组织结构、是否存在瓣膜病变,并可进行有效测量,为临床医师提供术前准备、术后随访影像学依据。MSCT与超声心动图检查在主动脉根部测量上存在差异。     

经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄中的CT评估

目的 探讨经导管主动脉瓣置换术（TAVR）治疗二叶式主动脉瓣狭窄的临床疗效和术前评估要点。 方法 纳入阜外医院2020年1月~2020年12月完成的TAVR患者54例。分析主动脉根部形态学特点、手术有效性及安全性。 结果 三组瓣膜选择的oversize（测量瓣环直径/选择瓣环直径?1）为: ?0.22 ± 8.62 %vs. 0.53 ± 8.37 % vs. 8.02 ± 6.71 %。三叶瓣组与功能二叶瓣组及解剖二瓣化组相比,3mensio测量的瓣环的平均直径、流出道平均直径、窦管交界平均直径和升主动脉平均直径数值均较小,有显著的统计学差异（P<0.01）;左右冠的开口高度及右窦的大小数值均较小（P<0.05）。中转外科手术、术中再次置入瓣膜、术中使用体外循环辅助、术中左室破裂、术后使用ECMO辅助、术后外周血管并发症、术后致残性脑卒中、死亡、术后起搏器植入和术后冠脉栓塞三组间比较无明显统计学差异。 结论 经导管主动脉瓣置换术对于二叶瓣的主动脉瓣狭窄的治疗是安全和有效的。术前CT的评估有着重要的意义。二叶瓣的瓣膜的选择建议downsize,解剖二叶瓣建议较大程度的downsize。     

主动脉瓣病变合并升主动脉扩张主动脉成形术后疗效分析

目的探讨主动脉瓣病变合并升主动脉扩张患者升主动脉成形术后的中期疗效。方法入选主动脉瓣病变合并升主动脉扩张患者34例,在全麻下行主动脉瓣置换同时行升主动脉成形术并对升主动脉应用人工血管外包裹,采用超声心动图测量手术前、出院前及随访（3～60）月的升主动脉直径,以观察升主动脉成形术后的中期疗效。结果围手术期无患者死亡。出院时升主动脉直径较术前减少[（29.4±5.1）mmvs.（46.2±7.2）mm,P〈0.05]。术后随访3～60个月,升主动脉直径（30.3±5.2）mm,较出院时无统计学差异（P〉0.05）。结论对于主动脉瓣病变合并升主动脉扩张的患者,升主动脉成形术同时应用人工血管外包裹的手术中期治疗效果良好。     

外科生物瓣毁损患者使用Venus-A人工瓣膜行经导管主动脉瓣置换术术前CT评估的方法与效果

目的 探讨术前计算机断层扫描(CT)评估外科主动脉生物瓣环内径中多平面曲线瓣环测量法及三维重建法测量间的差异以及基于CT结果指导外科生物瓣毁损患者使用Venus-A瓣膜行经导管主动脉瓣置换术(TAVR)的有效性及安全性.方法 回顾性分析2013年3月至2019年10月连续10例在外科毁损生物瓣中采用Venus-A瓣膜行...     

The effective orifice area/patient aortic annulus area ratio: a better way to compare different bioprostheses? A prospective randomized comparison of the Mosaic and Perimount bioprostheses in the aortic position

BACKGROUND AND AIM OF THE STUDY: The aim of this prospective, randomized study was to compare the hemodynamic performance of the Medtronic Mosaic and Edwards Perimount bioprostheses in the aortic position, and to evaluate prosthesis-specific differences in valve sizing and valve-size labeling. METHODS: Between August 2000 and September 2002, 139 patients underwent isolated aortic valve replacement (AVR) with the Mosaic (n = 67) or Perimount (n = 72) bioprosthesis. Intraoperatively, the internal aortic annulus diameter was measured by insertion of a gauge (Hegar dilator), while prosthesis size was determined by using the original sizers. Transthoracic echocardiography was performed to determine hemodynamic and dimensional data. As the aim of AVR is to achieve a maximal effective orifice area (EOA) within a given aortic annulus, the ratio of EOA to patient aortic annulus area was calculated, the latter being based on annulus diameter measured intraoperatively. RESULTS: Operative mortality was 2.2% (Mosaic 3.0%; Perimount 1.4%; p = NS). Upsizing (using a prosthesis larger in labeled valve size than the patient's measured internal aortic annulus diameter) was possible in 28.4% of Mosaic patients and 8.3% of Perimount patients. The postoperative mean systolic pressure gradient ranged from 10.5 to 22.2 mmHg in the Mosaic group, and from 9.4 to 12.6 mmHg in the Perimount group; it was significantly lower for 21 and 23 Perimount valves than for 21 and 23 Mosaic valves. The EOA ranged from 0.78 to 2.37 cm2 in Mosaic patients, and from 0.95 to 2.12 cm2 in Perimount patients. When indexing EOA by calculating the ratio of EOA to patient aortic annulus area to adjust for variables such as patient anatomy and valve dimensions, there was no significant difference between the two bioprostheses. CONCLUSION: Comparisons of absolute EOA values grouped by the manufacturers' valve sizes are misleading because of specific differences in geometric dimensions. The EOA:patient aortic annulus area ratio provides a new hemodynamic index which may facilitate objective comparisons between different valve types.     

垂体腺瘤鼻内镜蝶窦入路手术的局部影像解剖学测量

目的为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。方法利用双源CT三维重建技术对100例（200侧）鼻、鼻窦及颅底正常的受试者行蝶窦、蝶鞍区有关解剖数据的测量。结果鼻小柱根部至蝶窦前壁最近点、蝶嘴最前端、蝶鞍底最近点、蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的距离分别为（65.91±5.38）、（72.36±6.79）、（84.29±4.37）、（69.97±5.33）、（87.41±5.04）、（76.76±4.15）mm,鼻小柱根部至以上各解剖结构连线与鼻底平面的矢状角分别为25.17°±6.79°、16.19°±6.68°、26.12°±6.59°、31.17°±6.50°、23.64°±5.60°、38.15°±6.07°,鼻小柱根部至蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的连线与颅脑正中矢状面的侧偏角分别为4.13°±1.47°、7.92°±1.41°、11.28°±1.89°。结论利用双源CT三维重建技术可以地为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。     

Hemodynamic performance of the new St. Jude Medical Epic Supra porcine bioprosthesis in comparison to the Medtronic Mosaic on the basis of patient annulus diameter

BACKGROUND AND AIM OF THE STUDY: The St. Jude Medical Epic Supra (ES) valve is a new porcine bioprosthesis designed for complete supra-annular implantation. To date, no in-vivo data regarding the hemodynamic and clinical performance of this valve are available. The study aim was to compare the hemodynamic performance of the ES valve with the completely supra-annular Medtronic Mosaic (MM) porcine valve. METHODS: Between July 2000 and April 2006, 83 patients (39 males, 44 females) underwent aortic valve replacement with either the ES (n = 44) or MM (n = 39) bioprosthesis. Hemodynamic performance was evaluated echocardiographically at six months postoperatively. Comparison between the valves was performed by dividing the patient groups according to their intraoperatively measured tissue annulus diameter rather than the labeled valve size. RESULTS: The internal diameter and sewing ring diameter differed in ES and MM valves with the same labeled size. For example, in valves labeled '23' the internal diameter/sewing ring diameters were 21.5 and 29.3 mm in the ES valve versus 20.5 and 30 mm in the MM. The mean pressure gradients (MPG) for patients with ES or MM valves were 15.5 +/- 4.5 or 14.8 +/- 5.1 mmHg for annulus diameter < or =22 mm, 14.6 +/- 6.4 or 13.9 +/- 3.6 for annulus diameter 23-24 mm, and 15.3 +/- 3.8 or 13.4 +/- 4.2 mmHg for annulus diameter > or =25 mm. No significant differences were identified in the hemodynamic data, including MPG, effective orifice area (EOA) and effective orifice area index (EOAI). The incidence of moderate or severe patient-prosthesis mismatch (PPM) was 40% (n = 18) and 5% (n = 1) in patients with ES valves, and 26% (n = 10) or 23% (n = 9) in patients with MM valves (p = 0.01). In patients with an annulus size < or =22 mm, severe PPM occurred in 29% (n =5) of patients with MM valves but in none of those with ES valves. CONCLUSION: The hemodynamic performance of the ES valve was comparable to that of the well-established MM valve. The incidence of severe PPM was lower in patients with ES valves than MM valves, presumably due to the somewhat larger EOA values in patients with a small aortic annulus (<25 mm).     

Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report

Balloon valvuloplasty in neonates with severe aortic valve stenosis is limited by difficulties in catheter manipulation around the arch and across the valve and by the risk of femoral artery complications. A right common carotid artery cutdown was utilized for balloon aortic valvuloplasty in five neonates 1 to 20 days of age, weighing 3.1 to 3.9 kg. Standard balloon valvuloplasty was performed through a 6F sheath inserted in the right carotid artery. The arteriotomy was repaired at the end of the procedure. Mean left ventricular systolic pressure was reduced from 142 to 97 mm Hg, with a decrease in mean peak systolic pressure gradient from 76 to 33 mm Hg. Only one patient developed mild aortic regurgitation. One patient with a hypoplastic left ventricle died, and one patient required open valvotomy. All four survivors have a normal carotid pulse and no neurologic sequelae. Two of these patients required repeat balloon dilation to treat residual aortic valve stenosis at 8 and 10 months of age, respectively. Balloon valvuloplasty using a carotid artery approach is feasible and was safe in five neonates with severe aortic valve stenosis.     

重度主动脉瓣狭窄患者瓣环径二维及三维测量方法的比较

目的 比较不同的二维及三维方法对重度主动脉瓣狭窄患者瓣环径测值的差别,探讨最优测量手段.方法 32例重度主动脉瓣狭窄患者,分别行二维经胸超声心动图（TTE）、二维经食管超声心动图（TEE）及多排螺旋CT（MSCT）三维成像测量主动脉瓣环径.结果 MSCT显示主动脉瓣环为椭圆形结构,其长轴径（26.9±2.9）mm,短轴径（21.3±1.8）mm,长轴径与短轴径差异有统计学意义（P＜0.01）.TTE及TEE方法仅提供一个瓣环值,分别为（23.2±2.0）mm及（23.4±2.0）mm,均显著小于MSCT所测长轴径和短轴径的平均值（24.1±2.1）mm（P＜0.05）.结论 主动脉瓣环为椭圆形,瓣环径的测量采用三维MSCT方法更佳.     

Accuracy of echocardiography for assessing aortic root diameter.

The normal range for aortic root diameters employing the echocardiographic continuous recording technique was determined in 159 adult subjects without aortic valve disease or hypertension. In order to evaluate the accuracy of this noninvasive technique, the aortic root diameters as measured by ultrasound before operation in 31 patients with aortic valve disease were compared with their respective aortic annulus diameters as determined at the time of valve replacement. The 159 normal subjects consisted of 78 men and 81 women whose ages ranged from 18 to 74 pears (average 38). The normal range of aortic root diameters in this group was 17 to 33 mm (mean 23.7). A significant difference (P is smaller than 0.001) in aortic root diameters existed between men and women which could not be explained by differences in body surface area. The mean diameter among the 81 women was 22.4 plus or minus 3.3 mm(I SD) compared to the mean diameter in the 78 men of 25 plus or minus 3.5 mm. These results indicate a normal range for aortic root diameters which is significantly lower than previously reported. The aortic root diameter which was measured reoperatively by ultrasound in the 31 patients with aortic valve disease averaged 25.1 plus or minus 1.9 mm and did not differ significantly from the actual aortic annulus diameter of 25.5 plus or minus 2.6 mm measured at the time of surgery. The aortic root measurements by echo were within 2 mm of the corresponding annulus diameter in 25 of the 31 operated patients (80%).     

Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement

Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.     

Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement

Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient’s body size, thus resulting in high residual postoperative pressure gradients across the prosthesis. Severe PPM occurs in 2% to 20% of patients undergoing surgical aortic valve replacement (AVR) and is associated with 1.5- to 2.0-fold increase in the risk of mortality and heart failure rehospitalization. The purpose of this article is to present an overview of the role of multimodality imaging in the assessment, prediction, prevention, and management of PPM following AVR. The risk of PPM can be anticipated at the time of AVR by calculating the predicted indexed from the normal reference value of EOA of the selected prosthesis and patient’s body surface area. The strategies to prevent PPM at the time of surgical AVR include: 1) implanting a newer generation of prosthetic valve with better hemodynamic; 2) enlarging the aortic root or annulus to accommodate a larger prosthetic valve; or 3) performing TAVR rather than surgical AVR. The identification and quantitation of PPM as well as its distinction versus prosthetic valve stenosis is primarily based on transthoracic echocardiography, but important information may be obtained from other imaging modalities such as transesophageal echocardiography and multidetector computed tomography. PPM is characterized by high transprosthetic velocity and gradients, normal EOA, small indexed EOA, and normal leaflet morphology and mobility. Transesophageal echocardiography and multidetector computed tomography are particularly helpful to assess prosthetic valve leaflet morphology and mobility, which is a cornerstone of the differential diagnosis between PPM and pathologic valve obstruction. Severe symptomatic PPM following AVR with a bioprosthetic valve may be treated by redo surgery or the transcatheter valve-in-valve procedure with fracturing of the surgical valve stent.