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Review
. 2014 Jun 21;35(24):1578-87.
doi: 10.1093/eurheartj/eht569. Epub 2014 Jan 23.

Imaging to select and guide transcatheter aortic valve implantation

José Luis Zamorano  1 , Alexandra Gonçalves  2 , Roberto Lang  3
Affiliations
Review

Imaging to select and guide transcatheter aortic valve implantation

José Luis Zamorano et al. Eur Heart J. .

Abstract

Transcatheter aortic valve implantation (TAVI) is indicated for patients with severe aortic stenosis and high or prohibitive surgical risk. Patients' selection requires clinical and anatomical selection criteria, being the later determined by multimodality imaging evaluation. Echocardiography, multislice computed tomography (MSCT), angiography, and cardiovascular magnetic resonance (CMR) are the methods available to determine the anatomical suitability for the procedure. Imaging assists in the selection of bioprosthesis type, prosthetic sizing and in the decision of the best vascular access. In this review, we present our critical appraisal on the use of imaging to best patients' selection and procedure guidance in TAVI.

Keywords: Aortic stenosis; Imaging; Transcatheter aortic valve implantation.

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Figures

Figure 1
Figure 1
Multidisciplinary approach to transcatheter aortic valve implantation .
Figure 2
Figure 2
Cardiac magnetic resonance view of aortic valve area planimetry (A and B) and aortic annulus measurements (C).
Figure 3
Figure 3
Multislice detector computed tomography (A and C) and three-dimensional TOE (B and D) measuring the distance between annulus and coronary ostia. LCA, left coronary artery; RCA, right coronary artery.
Figure 4
Figure 4
Transoesophageal echocardiography view for the measurement of aortic annular dimension.
Figure 5
Figure 5
Three-dimensional transoesophageal echocardiography assessing shape and measurements of the aortic annulus (A and C). The aortic annulus measured by two-dimensional echocardiography (B) acquires images (yellow dotted line) that are in-between the short- and long-axis views of the oval-shaped annulus.
Figure 6
Figure 6
Cardiac CT (A and B) and three-dimensional transoesophageal echocardiograph (C and D) can be interchangeably used to assess the shape and obtain measurements of the aortic annulus.
Figure 7
Figure 7
Multislice computed tomography assessing aortic valve calcification and reconstruction of the aortic root and ascending aorta. Additionally, the minimal and maximal diameters are measured at the level of aortic annulus (A).
Figure 8
Figure 8
Multislice computed tomography (A, rendered image and B, MIP) view of the femoral arteries depicting calibre, tortuosity, and calcification.
Figure 9
Figure 9
Three-dimensional transoesophageal echocardiography showing the catheter and the prosthesis through the native aortic valve while being deployed.
Figure 10
Figure 10
Two-dimensional transoesophageal echocardiography showing paravalvular aortic regurgitation.
See this image and copyright information in PMC

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