Imaging techniques in transcatheter aortic valve replacement (original) (raw)
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Current Treatment Options in Cardiovascular Medicine, 2016
I THV I Echocardiography I Cardiac CT I Aortic stenosis I Valve disease Opinion statement Transcatheter valve interventions have emerged as one of the most important developments in structural heart disease over the past 20 years. Initially, these interventions were directed at patients with severe aortic stenosis and high surgical risk; however, their applications have extended to involve other native valves' pathologies, degenerated prosthetic valves, as well as patients of lower surgical risk. In this article, we discuss the importance of cardiac imaging in transcatheter aortic valve replacement (TAVR) by exploring the current practices, guidelines, and recommendations with the supporting data. We believe that the key for a successful TAVR is careful pre-procedural planning and early detection of any possible post-implantation complications. To achieve this, multimodality imaging is cornerstone. Throughout the stages of patient-evaluation, echocardiography and computed tomography play complementary roles. MRI, on the other hand, has emerged as a useful tool in quantifying post-implantation paravalvular regurgitation. Generations Sapien Sapien XT Sapien 3 CoreValve CoreValve Evolut Valve size (mm)
Computed tomography in the evaluation for transcatheter aortic valve implantation (TAVI)
Cardiovascular diagnosis and therapy, 2011
If left untreated, symptomatic, severe aortic stenosis (AS) is associated with a dismal prognosis. Open-heart surgical valve replacement is the treatment of choice and is associated with excellent short and long-term outcome. However, many older patients with multiple co-morbidities and anticipated increased surgical risk are excluded from surgical intervention. For these patients, transcatheter aortic valve implantation (TAVI) is emerging as a viable treatment alternative. Transcatheter valvular heart procedures are characterized by lack of exposure and visualization of the operative field, therefore relying on image guidance, both for patient selection and preparation and the implantation procedure itself. This article describes the role of multi-detector row computed tomography (MDCT) for detailed assessment of the aortic valve, aortic root, and iliac arteries in the context of TAVI.
Imaging to select and guide transcatheter aortic valve implantation
European Heart Journal, 2014
Transcatheter aortic valve implantation (TAVI) is indicated for patients with severe aortic stenosis and high or prohibitive surgical risk. Patients' selection requires clinical and anatomical selection criteria, being the later determined by multimodality imaging evaluation. Echocardiography, multislice computed tomography (MSCT), angiography, and cardiovascular magnetic resonance (CMR) are the methods available to determine the anatomical suitability for the procedure. Imaging assists in the selection of bioprosthesis type, prosthetic sizing and in the decision of the best vascular access. In this review, we present our critical appraisal on the use of imaging to best patients' selection and procedure guidance in TAVI.
Echocardiography for transcatheter aortic valve implantation
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2009
Transcatheter aortic valve implantation (TAVI) is a new technology that treats severe aortic stenosis. The technology has specific and mandatory technical requirements that must be met to allow safe and successful procedures. The echocardiographic method for diagnosis of aortic stenosis, anatomical case selection, procedural guidance and management of complications is discussed in this context. The role of the imaging specialist is defined within the TAVI team aiming to provide good outcomes for this high risk cohort of patients.
Role of Multislice Computed Tomography in Transcatheter Aortic Valve Replacement
The American Journal of Cardiology, 2009
Transcatheter aortic valve replacement (TAVR) required precise knowledge of the anatomic dimensions and physical characteristics of the aortic valve, annulus, and aortic root. Most groups currently use angiography, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) to assess aortic annulus dimensions and anatomy. However, multislice computed tomography (MSCT) may allow more detailed 3-dimensional assessment of the aortic root. Twenty-six patients referred for TAVR underwent MSCT. Scans were also obtained for 18 patients after TAVR. All patients underwent preand postprocedural aortic root angiography, TTE, and TEE. Mean differences in measured aortic annular diameters were 1.1 mm (95% confidence interval 0.5, 1.8) for calibrated angiography and TTE, ؊0.9 mm (95% confidence interval ؊1.7, ؊0.1 mm) for TTE and TEE, ؊0.3 mm (95% confidence interval ؊1.1, 0.6 mm) for MSCT (sagittal) and TTE, and ؊1.2 mm (95% confidence interval ؊2.2, ؊0.2 mm) for MSCT (sagittal) and TEE. Coronal systolic measurements using MSCT, which corresponded to angiographic orientation, were 3.2 mm (1st and 3rd quartiles 2.6, 3.9) larger than sagittal systolic measurements, which were in the same anatomic plane as standard TTE and TEE views. There was no significant association between either shape of the aortic annulus or amount of aortic valve calcium and development of perivalvular aortic regurgitation. After TAVR, the prosthesis extended to or beyond the inferior border of the left main ostium in 9 of 18 patients (50%), and in 11 patients (61%), valvular calcium was <5 mm from the left main ostium. In conclusion, MSCT identified that the aortic annulus was commonly eccentric and often oval. This may in part explain the small, but clinically insignificant, differences in measured aortic annular diameters with other imaging modalities. MSCT after TAVR showed close proximity of both the prosthesis and displaced valvular calcium to the left main ostium in most patients. Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR.
The role of echocardiography in transcatheter aortic valve implantation
Interventional Cardiology, 2014
Aortic stenosis is a common valve disease with increasing prevalence in the elderly. The presence of comorbidities in this population can make surgical aortic valve replacement challenging; therefore, transcatheter aortic valve implantation is increasingly being offered as a management option for these patients. Imaging with echocardiography has an important role through all aspects of the procedure from initial imaging and patient selection, guidance of the procedure and assessment of complications.
Cardiovascular Imaging Asia, 2018
The indications of the transcatheter aortic valve replacement (TAVR) procedure have been widely expanded and the number of cases has significantly increased in the past 15 years due to continued evolution of prosthetic devices, increased experience of cardiologists, and advancements in the cardiovascular imaging field. In this review article, we summarize updates on TAVR guidelines, state-of-the-art prosthetic devices, recommended pre-and post-procedural multi-detector computed tomography (MDCT) protocols, required imaging parameters and measurements, and post-procedural complications. We also address issues concerning the Asian population and patients with bicuspid aortic valve and emphasize some of the challenges ahead. MDCT is the recommended modality of choice for pre-procedural planning for TAVR and current guidelines state that MDCT should be performed by well-trained personnel and interpreted and analyzed by experienced radiologists who not only have a sound understanding of TAVR with respect to its indications, prosthetic devices, procedure, and complications, but also work in close collaboration with the Heart Team.