Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure in the treatment of aortic valve stenosis in patients with medium to high surgical morbidity and mortality (1). Computed tomography (CT) is the mainstay imaging modality in pre-operative TAVI planning for accurate measurement of the aortic annulus for device selection and assessment of patient suitability to minimise the risk of paravalvular leak and aortic rupture. The conventional TAVI CT protocol involves a retrospective ECG-gated systolic cardiac acquisition followed by a non-gated acquisition through the chest,...

Retrospective audit of consecutive patients who underwent TAVI planning at the Royal Melbourne Hospital from 26 April 2021 to 30 March 2022 was conducted. The inclusion criteria were patients who underwent pre-operative TAVI planning with CT including both retrospective ECG gated cardiac acquisition and ECG triggered systolic high pitch helical acquisition of the chest, abdomen and pelvis. The images were acquired using dual-source 256 section multi-detector CT scanner (SOMATOM Definition Flash, Siemens). The retrospective helical acquisition through the whole heart (carina to apex) with ECG-gating...

A total of 132 patients were included in the study, 77 (58%) were male with median age of 82 (IQR 77-86 years). 93/132 (70%) had diagnostic quality high-pitch retrospective helical acquisition for annulus measurement (> 250 HU and closed mitral valve) (table 1). Of the 39/132 patients with annulus misregistration artefact, 25/39 (64%) had a diagnostic salvage high-pitch helical acquisition. Overall, 92% of all patients therefore had one diagnostic aortic annulus sequence, and 11/132 had a follow up repeat diagnostic study. 121/132 (92%) had diagnostic...

Systolic high-pitch helical acquisition as part of TAVI workup protocol CT achieved diagnostic aortoiliofemoral runoff opacification in >90% of the scans and was able to salvage the majority of patients with annulus misregistration artifact in the initial retrospective acquisition, without need for additional contrast or radiation dose from a repeat study. Overall, 92% of the combined retrospective ECG-gated cardiac and systolic ECG-triggered high-pitch FLASH acquisition for run-off with a single scan and contrast bolus were of diagnostic quality for TAVR planning. In this audit, 72%...

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