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. 2015 Apr 26;7(4):178-86.
doi: 10.4330/wjc.v7.i4.178.

Practical update on imaging and transcatheter aortic valve implantation

Gisela Feltes  1 , Iván J Núñez-Gil  1
Affiliations

Practical update on imaging and transcatheter aortic valve implantation

Gisela Feltes et al. World J Cardiol. .

Abstract

After very rapid advances in the development of the technique and devices, transcatheter aortic valve implantation (named TAVI or TAVR), is today a reality that is here to stay. It has become the minimally-invasive treatment option for high-risk and non-surgical patients with severe symptomatic aortic stenosis. Requiring the participation of a multidisciplinary team for its implementation, cardiac imaging plays an important role. From pre-assessment to determine the suitability of the patient, the access site, the type of device, to the guidance during the procedure, and ultimately the long term monitoring of the patient. Correct selection of the patient and device, correct placement of the stent-valve and early detection of complications are of paramount importance for procedural success and for patient outcome. Each technique has advantages and disadvantages, being the cardiologist who will determine the best approach according to the type of patient and the expertise of the center in each one of them. This article summarizes the last contributions of the most common used imaging techniques, in each step of the procedure.

Keywords: Aortic stenosis; Cardiac magnetic resonance; Echocardiography; Multislice tomography; TAVI; TAVR.

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Figures

Figure 1
Figure 1
Transesophageal echocardiography 2D at 129° in long axis view in systole with measurements of the left ventricular outflow tract and aortic annulus. The measurement in blue is the distance to the rigth coronary artery.
Figure 2
Figure 2
Transesophageal echocardiography 3D with multiplanar projection showing the measurements at annulus level.
Figure 3
Figure 3
Computed tomography with multiplanar reconstruction showing measurements at different levels of the aorta.
Figure 4
Figure 4
Computed tomography images showing aortic anatomy and calcifications, previous to transcatheter aortic valve implantation procedure.
Figure 5
Figure 5
T1 weighted cardiac magnetic resonance image depicting aorta measurements.
Figure 6
Figure 6
Fluoroscopy images showing different prosthesis models. A: CoreValve evolut R; B: Direct Flow valve; C: Edward Sapien 3; D: Edward Sapien XT.
Figure 7
Figure 7
Transesophageal echocardiography at 46°without and with color Doppler showing 3 paravalvular leaks (arrows) after valve implantation.
Figure 8
Figure 8
Transesophageal echocardiography 3D full volume showing the exact position of an important paravalvular leak.
Figure 9
Figure 9
Transesophageal echocardiography at 114° without and with color Doppler depicting the presence of central aortic regurgitation due to underexpansion of the prosthesis.
See this image and copyright information in PMC

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