Technique Advantages Disadvantage
TTE Non-invasive method that provides evaluation on prosthetic valve function. Limited by acoustic shadowing and artifact from the prosthetic valve leading to sometimes poor grading of severity and aetiology differentiation.
Can provide volumetric quantitation. It may be unfeasible to use colour Doppler in imaging paravalvular regurgitation
It is cheaper as it requires less costly resources. 2D and 3D image resolution is lower.
TOE Accurately determines the severity, mechanism, and location of the PVL. Limited by acoustic shadowing and artifact from the prosthetic valve.
Best imaging method to visualise prosthetic valve tears. Requires trained physicians, patient sedation and mechanical ventilation.
Invasive and therefore may cause injury to the oesophagus.
Cardiac CT Can be used preoperatively to identify the size and shape of the annulus and calcification degree to reduce the risk of developing PVL. An intravenous contrast is needed to see an image which can be nephrotoxic.
The patient is exposed to radiation whilst undergoing the scan.
Tachycardiac patients have poor temporal resolution.
Cardiac MRI It can be used in patients with both mechanical and prosthetic valves. Can overestimate the severity of the PVL.
The images obtained have good quality. Assessment accuracy can be affected by tachyarrhythmias.
There is non-need for the use contrasting agents. Poor imaging received with mechanical valve.