To illustrate how to perform correctly a CT angiography,
in terms of technical parameters and contrast medium (CM) infusion protocol,
in patients with symptomatic severe aortic valve stenosis eligible for aortic valve prosthesis implantation using TAVI/TAVR (Transcatheter Aortic Valve Implantation/Replacement);
To illustrate the imaging evaluation criteria focused on correct prosthesis choice and the procedure planning,
from vascular access to implantation.
Patients with severe symptomatic aortic stenosis,
mostly when associated with left ventricular dysfunction,
are subjects with impairment of quality of life and reduced overall survival if not treated in the short term .
In these patients,
the most widespread and proven elective treatment,
capable to positively modify prognosis and life expectancy,
is the prosthetic aortic valve replacement (biological or mechanical) with cardiac surgery.
the surgical approach,
considered at low-risk mortality in most of the population,
may represent a non-viable therapeutic option in those patients...
Findings and procedure details
CT angiography for TAVI planning must be carried out using a CT multidetector device (CTMD) with at least 64 detectors,
a minimum spatial resolution between 0.6 and 0.5 mm and a dedicated workstation.
The scanning protocol is based on two acquisitions:
a retrospectively "ECG-gated" acquisition in meso/tele-systolic cardiac phase,
focused on studying the aortic annulus and the aortic root;
a second acquisition,
performed without cardio-synchronization,
aimed to evaluate the thoraco-abdominal aorta,
from the pulmonary apexes to the femoral bifurcations (Figure 1).
A single bolus...
The planning of the TAVI procedure needs a multidisciplinary approach in which nowadays CT angiography plays a consolidated role,
currently representing the gold standard.
The correct positioning of the transcatheter device is based on the multimodality approach of the imaging carried out in the pre-procedural discussion.
The knowledge of the technical parameters necessary to obtain a high-quality imaging is important for a correct execution of the examination,
as well as being familiar with the infusion protocols which have to be performed.
Even more essential is...
Francesco Serafini (email@example.com)
Daniela Gabrielli (firstname.lastname@example.org)
Antonio Raffaele Cotroneo (email@example.com)
Imaging and Clinical Science Department
d'Annunzio" University - Chieti-Pescara
Via dei Vestini
66100 - Chieti
A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis.American Journal of Cardiology,
2017 ESC/EACTS Guidelines for the management of valvular heart disease.European Heart Journal,
et al.Access Sites for TAVI: Patient Selection Criteria,
and Outcomes.Frontiers in Cardiovascular Medicine,(2018),