Type:
Educational Exhibit
Keywords:
Haemodynamics / Flow dynamics, Contrast agent-intravenous, Catheters, Arterial access, Percutaneous, CT-High Resolution, Catheter arteriography, Interventional vascular, Cardiac, Arteries / Aorta
Authors:
F. Messina, M. Medda, M. Bande, A. Ielasi, F. Casilli, A. Silvestro, M. Criscuolo; Milan/IT
DOI:
10.26044/ecr2019/C-3021
Background
Aortic stenosis (AS),
a degenerative valvular heart disease,
is a major cause of morbidity and mortality in the aging population of industrialized countries [1-2].
Trans-catheter aortic valve implantation (TAVI) has emerged as a viable treatment option for patients with severe native aortic valve stenosis at high or moderate risk for surgery [3].
Bio-prosthetic surgical heart valves (BSHV),
on the other side,
have limited durability leading to degeneration and subsequent malfunction.
Because of the high-risk of redo surgery,
TAVI within a degenerate bio-prosthesis (valve-in-valve –VIV- procedure) could represent an effective and less invasive alternative to surgery [4],
although with some technical challenges.
On these basis,
procedural planning by the ECG-gated angio computed tomography (angio-CT) to evaluate the peripheral vessels,
valve leaflets’ calcification,
valve perimeter/diameter,
aortic root,
and coronary artery anatomy is necessary to reduce the risk of complications and to achieve a successful result in the TAVI procedure [5-6].
In our institution (Sant’Ambrogio Cardio-Thoracic Center,
Milan,
Italy) radiographers are involved in TAVI procedures in the pre-procedural assessment (chest X-Ray,
angio-CT acquisition and evaluation),
but also in the catheterization laboratory (Cath-Lab) during the prosthesis’ preparation and implantation.