Bioprosthetic Heart Valve Degeneration and Dysfunction: Focus on Mechanisms and Multidisciplinary Imaging Considerations.

Bioprosthetic heart valves (BPHVs) have fundamentally changed the treatment of valvular heart disease. Despite the continuous progress of BPHVs, from early valve designs for use in surgical replacement to the rapidly evolving use of transcatheter replacement techniques and designs, valve dysfunction and degeneration remain fundamental issues. Current guidelines and proposed standard definitions of BPHV dysfunction and degeneration outline the importance of imaging. Imaging plays a key role in understanding valve degeneration, including clinical imaging to identify transvalvular gradients, leaflet thickening, thrombosis, calcification, and restricted or reduced leaflet motion. Similarly, translational imaging approaches-including micro-CT, high-speed video, computational modeling, and high-resolution microscopy-and histologic analysis are crucial to understanding mechanisms of valve degeneration and factors that may contribute to valve dysfunction. This article provides an overview of valve dysfunction and degeneration and the role of imaging. © RSNA, 2019.