Leaflet motion abnormality after TAVI: genuine threat or much ado about nothing?

Symptomatic transcatheter heart valve (THV) thrombosis is noted in up to 1% of patients after transcatheter aortic valve replacement. Recently, hypoattenuated leaflet thickening and reduced leaflet motion of bioprosthetic aortic valves associated with normal transvalvular gradients (and possibly related to subclinical leaflet thrombosis) have been reported. While trans-thoracic echocardiography is a useful initial screening imaging modality for the detection of symptomatic THV thrombosis associated with elevated transvalvular gradients, it has limited utility in the detection of subclinical THV thrombosis. In the present article, we describe the incidence, clinical presentation and strategies for the prevention and treatment of THV thrombosis, as well as the role of imaging modalities in the diagnosis and management of this phenomenon.