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Review
. 2018 Feb 12;20(2):9.
doi: 10.1007/s11886-018-0949-z.

The Pivotal Role of Imaging in TAVR Procedures

Caroline Bleakley  1 , Mark J Monaghan  2
Affiliations
Review

The Pivotal Role of Imaging in TAVR Procedures

Caroline Bleakley et al. Curr Cardiol Rep. .

Abstract

Purpose of review: Transcatheter aortic valve replacement (TAVR) is underpinned by an array of imaging techniques designed to not only select an appropriately sized implant but also to identify potential obstacles to procedural success. This review presents currently important aspects of TAVR imaging, describing the salient features of each modality as well as recent developments in the field.

Recent findings: The latest data on TAVR outcomes reflects the increasing experience of operators and the significant role of pre-procedural imaging. Debate continues as to which modality sizes the aortic annulus most accurately, 3D transoesophageal echocardiography (TEE) or MDCT, as well as to whether the merits of real-time peri-procedural 3D imaging guidance outweigh the possible adverse consequences of general anaesthesia which is requisite for intraprocedural 3D TEE. TAVR is now largely based on pre-acquired roadmaps of the truncal vasculature and intense pre-procedural planning. TEE and Multi-detector computed tomography (MDCT) have been shown to perform similarly in annulus sizing. However, given the complexity of many TAVR patients and the importance of identifying the most suitable pathway to the valve as well as any potentially confounding other structural or functional heart disease, both modalities remain relevant in current TAVR.

Keywords: 3D transoesophageal echo; Aortic stenosis; Transcatheter aortic valve implantation.

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Conflict of interest statement

Conflicts of Interest

C.B. and M.J.M. declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Graphical depiction of the aortic annulus. The virtual ring formed by the basal hinge points of the valve cusps is the measured annulus in TAVR sizing
Fig. 2
Fig. 2
Example of 3D TEE annular sizing. The yellow lines drawn by the operator measure the annulus and sinus of Valsalva dimensions. Upper left panel = sagittal view; upper right panel = transverse view; bottom left panel = coronal view
Fig. 3
Fig. 3
Coronal (a) and axial (b) views of the truncal vasculature. The arrows point to the aortofemoral bifurcation in the coronal image and the left and right femoral arteries in the axial image
Fig. 4
Fig. 4
The EchoNavigator™ system allows real-time fusion of fluoroscopy (left side) and TEE (right side) images allowing the operator to see the aortic apparatus in 3D for optimal valve positioning. The arrow points to the pre-deployment Edwards Sapien™ valve seen within the 3D arrangement of the aortic annulus. The TEE probe seen just above is positioned cranially so as not to interfere with fluoroscopic imaging
See this image and copyright information in PMC

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