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Transcatheter heart valve (THV) dysfunction with an elevated gradient or paravalvular leak (PVL) may be documented late after THV implantation. Medical management, paravalvular plugs, redo THV replacement, or surgical valve replacement may be considered. However, late balloon dilatation is rarely utilized due to concerns about safety or lack of efficacy. Transcatheter heart valve (THV) dysfunction with an elevated gradient or paravalvular leak (PVL) may be documented late after THV implantation. Medical management, paravalvular plugs, redo THV replacement, or surgical valve replacement may be considered. However, late balloon dilatation is rarely utilized due to concerns about safety or lack of efficacy. We aimed to evaluate the safety and efficacy of late dilatation in the management of THV dysfunction. All patients who underwent late dilatation for symptomatic THV dysfunction at two institutions between 2016 and 2021 were identified. Baseline, procedural characteristics, clinical and echocardiographic outcomes were documented. THV frame expansion was assessed by multislice computed tomography (MSCT) before and after late dilatation. Late dilatation was performed in 30 patients a median of 4.6 [2.3–11.0] months after THV implantation in the aortic (n = 25; 83.3%), mitral (n = 2; 6.7%), tricuspid (n = 2; 6.7%) and pulmonary (n = 1; 3.3%) position (Fig. 1). THV under expansion was documented at baseline, and frame expansion substantially improved after late dilatation. The mean transvalvular gradient fell in all patients. For aortic THVs specifically, mean transaortic gradient fell from 25.4 ± 13.9 mmHg to 10.8 ± 4.1 mmHg (P < 0.001). PVL was reduced to £ mild in all 11 patients with a previous > mild PVL (Fig. 1). Embolic events, stroke, annular injury, and bioprosthetic leaflet injury were not observed. Symptomatic benefit was durable at 19.6 [14.8–36.1] months follow-up. Balloon dilatation late after THV implantation appears feasible and safe in appropriately selected patients and may result in THV frame expansion resulting in improvements in hemodynamic performance and PVL. [ABSTRACT FROM AUTHOR]

Bioprosthetic valve thrombosis (BPVT) is a recognised complication of prosthetic aortic valves and can be found in up to 13% of patients after transcatheter implantation. The mechanism of BPVT is not well known, abnormal flow conditions in the new and native sinuses and lack of functional endothelialisation are suspected causes. BPVT may result in valve dysfunction, possibly related to degeneration, and recurrence of patient symptoms, or remain subclinical. BPVT is best diagnosed at multiphase gated computed tomography (CT) angiography as the presence of reduced leaflet motion (RELM) and hypoattenuating aortic leaflet thickening (HALT). Although CT is used to exclude BPVT in symptomatic patients and those with increased valve gradients, the value of screening and prophylactic anticoagulation is debatable. [ABSTRACT FROM AUTHOR]