Pre-TAVI MDCT assessment: dos and don'ts.

Congress:

ESCR 2019

Poster Number:

P-0028

Type:

Poster Abstract

Keywords:

Cardiac Assist Devices, Arteriosclerosis, Arterial access, CT-Angiography, Cardiac, Arteries / Aorta

Authors:

F. Paciolla¹, G. Rovere¹, B. Merlino², L. Natale¹, R. Marano², R. Manfredi²; ¹roma/IT, ²Rome/IT

DOI:

DOI-Link:

https://dx.doi.org/

Fig. 1: Normal tricuspid confromation of the aortic valve, diastolic phase. You can...

Fig. 2: Bicuspid aortic valve with a raphe between right coronary and left coronary...

Fig. 3: Valvular and subvalvular calcification should be qualitatively described...

Purpose

The purpose of this exhibit is to show howto assess the morphology and measurements of aortic root, aorta and peripheral arteries using MDCT multiplanar imaging before transcatheter aortic valve implantation (TAVI).

Methods and Materials

The development of transcatheter aortic valve implantation (TAVI) allowed a practicable way to treat severe aortic stenosis. The latesttrials (SURTAVI, PARTNER 3) suggest to broaden indications for TAVI to low-risk surgical patients. Pre-procedural imaging with MDCT is required to determine the appropriate approach and the proper device; it implies the assessment of the morphology of the aortic valve, the aortic root, a global study of the anatomy of the aorta and peripheral arteries. MDCT provides detailed information on the cardiac anatomy and 3D volumetric data...

Results

Evaluation of the aortic valve should start with conﬁrmation of the aortic valve morphology, differentiating tricuspid from bicuspid valvular anatomy. It can be improved with additional systolic reconstruction using ECG-gating, which allows differentiation between a tricuspid valve (Fig.1) and a bicuspid valve with raphe (Fig.2). Description and quantification of the aortic valve calciﬁcation is important (Fig.3):very bulky calciﬁcation at the edge of native valvular leaﬂets has been related to increased risk of coronary occlusion when it is displaced over the coronary ostium. Furthermore, heavy calciﬁcation...

Conclusion

CT imaging plays an important role in procedural planning for TAVI and should be a fully integrated component of any TAVI program. The use of CT is multifaceted and should include appropriate image acquisition and reconstruction as well as the comprehensive assessment the aortic root and vascular access.

Personal Information

References

1) Blanke P, Weir McCall JR, Achenbach S, Delgado V et al (2019), Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/ transcatheter aortic valve replacement (TAVR): an expert consensus document of Cardiovascular Computer Tomography. J Cardiovasc Comput Tomogr. 2) Alkadhi H, Leschka S, Trindade PT et al (2010) Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery. Am J Roentgenol 195:900–908 3) Webb JG, Chandavimol M, Thompson CR et al (2006) Percutaneous aortic valve...