Standard imaging techniques in transcatheter aortic valve replacement

Arash Salemi, Berhane M Worku, Arash Salemi, Berhane M Worku

Abstract

Transcatheter aortic valve replacement (TAVR) has become a widely accepted therapeutic option for patients with severe, symptomatic aortic stenosis at intermediate, high, or extreme risk for conventional surgery as determined through a heart team approach. Two valve prostheses are currently available and the Food and Drug Administration (FDA) approved in the United States for TAVR: the self-expandable Medtronic CoreValve (Medtronic, Inc., Minneapolis, MN, USA) and the balloon-expandable Edwards Sapien Valve (Edwards Lifesciences, Irvine CA, USA). The preoperative evaluation for TAVR includes transthoracic echocardiography (TTE) for the diagnosis of aortic stenosis. Cardiac computed tomography (CTA) has become the imaging modality of choice for annular sizing. Aortic root dimensions and coronary ostia height, and the degree of annular and left ventricular outflow tract calcification are also assessed to estimate the risk of coronary obstruction, annular rupture, and postoperative aortic regurgitation. Finally, CTA is essential to determine the adequacy of the peripheral vasculature for a transfemoral approach. Intraoperatively, fluoroscopy is mandatory for valve positioning, whereas the use of TTE or transesophageal echocardiography (TEE) varies by center. TTE is used for postoperative surveillance of valve function.

Keywords: Cardiac computed tomography (CTA); imaging; transcatheter aortic valve replacement (TAVR).

Conflict of interest statement

Conflicts of Interest: A Salemi serves as clinical proctor for Edwards Lifesciences, and Medtronic, Inc. BM Worku has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Edwards Lifesciences Sapien 3 Valve with outer skirt.
Figure 2
Figure 2
Medtronic CoreValve with nitinol frame.
Figure 3
Figure 3
CTA measurement of the annular area and perimeter. CTA, cardiac computed tomography.
Figure 4
Figure 4
CTA measurement of (A) right coronary height (B) Sinotubular and left coronary heights (C) diameter of sinuses (D) sinotubular junction diameter. CTA, cardiac computed tomography.
Figure 5
Figure 5
Annular and outflow tract calcium.
Figure 6
Figure 6
Aortic root angle.
Figure 7
Figure 7
Deployment angle.
Figure 8
Figure 8
Evaluation of iliofemoral anatomy.
Figure 9
Figure 9
Angiographic images of balloon valvuloplasty followed by Edwards Sapien valve deployment.
Figure 10
Figure 10
Intraoperative transesophageal short-axis evaluation of paravalvular AI. AI, aortic insufficiency.
Figure 11
Figure 11
Ideal deployment of the Sapien valve by aortography.
Figure 12
Figure 12
Markings delineating optimal landing zone on the CoreValve device.
Figure 13
Figure 13
Optimal deployment of the CoreValve device.
Figure 14
Figure 14
Valve-in-valve deployment of the Medtronic CoreValve.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner