In the most recent issue of the Journal of Cardiovascular Computed Tomography an international group of imaging specialists provides a consensus opinion about peri-procedural imaging prior to TAVR/TAVI.
The authors describe that CT plays an important role in the workup of high-risk patients with severe aortic stenosis (AS), who are potential candidates for TAVR/TAVI. Contrast-enhanced CT imaging provides information on the suitability of the peripheral access vessels to accommodate the relatively large sheaths necessary to introduce the prosthesis as well as aortic anatomy.
Importantly, CT imaging also provides accurate dimensions of the aortic annulus, which is importance for prosthesis sizing. The authors describe that initial data indicates that compared with echocardiographic sizing, CT-based sizing of the prosthesis may lead to better results avoiding postprocedural aortic valve regurgitation. Finally, CT permits one to predict appropriate fluoroscopic projections, which are oriented orthogonal to the aortic valve plane.
This consensus document provides recommendations about the use of CT imaging in patients scheduled for TAVR/TAVI, including data acquisition, interpretation, and reporting.
1. Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012 Nov;6(6):366-80. doi: 10.1016/j.jcct.2012.11.002. Epub 2012 Nov 14. PMID: 23217460
2. Kempfert J, Walther T. Learning experience with transapical aortic valve implantation – the initial series from Leipzig. Cardiovasc Diagn Ther 2012 Nov 29. DOI: 10.3978/j.issn.2223-3652.2012.11.05