Imaging in Transcatheter Aortic Valve Replacement (TAVR): role of the radiologist

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• 作者：Diana E. Litmanovich (1)
  Eduard Ghersin (2)
  David A. Burke (3)
  Jeffrey Popma (4)
  Maryam Shahrzad (1)
  Alexander A. Bankier (1)
  
• 关键词：TAVR ; Aortic annulus ; MDCT ; ECG ; gating ; Multiplanar reconstructions
• 刊名：Insights into Imaging
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：5
• 期：1
• 页码：123-145
• 全文大小：4,305 KB
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• 作者单位：Diana E. Litmanovich (1)
  Eduard Ghersin (2)
  David A. Burke (3)
  Jeffrey Popma (4)
  Maryam Shahrzad (1)
  Alexander A. Bankier (1)
  
  1. Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave-Shapiro 4, Boston, MA, 02215, USA
  2. Department of Radiology, Leonard M. Miller School of Medicine, University of Miami and Jackson Memorial Medical Center, 1611 NW 12 Avenue West Wing 279; LC: R-109, Miami, FL, 33136, USA
  3. Cardiovascular Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Road Palmer 4, Farr Building, Boston, MA, 02215, USA
  4. Department of Cardiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave-Shapiro, Boston, MA, 02215, USA
  
• ISSN：1869-4101

文摘

Background Transcatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities. Methods Since the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part. Results Among imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position. Conclusion This review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment. Teaching Points -TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates. -MDCT assessment of the aortic annulus is important for appropriate patient and device selection. -Multidisciplinary approach is required for patient selection, procedure planning and performance. -MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.