Role of computed tomography in transcatheter aortic valve implantation and valve-in-valve implantation: complete review of preprocedural and postprocedural imaging

Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures. Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT an...
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Reviews Source Type: research

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Authors: Yap J, Ewe SH, Chao V, Ho KW Abstract TAVI complications may occur in the peri- and postprocedural periods. A 79-year-old woman with known severe degenerative calcified aortic stenosis underwent transfemoral TAVI; prior to groin closure, she became hypotensive. Prosthetic valve thrombosis was confirmed with transesophageal echocardiography and computed tomography aortogram, which showed thrombus on the immobile non-coronary cusp leaflet. PMID: 31478897 [PubMed - in process]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
A 81-year-old male patient with chronic obstructive lung disease, decompensated severe calcified aortic stenosis, moderately to severely reduced biventricular systolic function, and atrial fibrillation with secondary pulmonary hypertension was referred to our institution. He was treated with diuretics, oral anticoagulants followed by low dose beta blocker. After cardiac recompensation coronary artery disease was excluded by coronary angiogram. Computed tomography (CT) angiography was performed prior to transcatheter aortic valve replacement (TAVR). Unexpectedly, CT (Panel C) and transthoracic echocardiography without contr...
Source: European Heart Journal - Category: Cardiology Source Type: research
Publication date: Available online 16 April 2019Source: Canadian Journal of CardiologyAuthor(s): Luca Baldetti, Francesco Giannini, Nicolas Van Mieghem, Nahid El Faquir, Didier Tchétché, Chiara De Biase, Anna Sonia Petronio, Cristina Giannini, Giuseppe Tarantini, Chiara Fraccaro, Ariel Finkelstein, Amit Segev, Israel Barbash, Giuseppe Bruschi, Corrado Tamburino, Marco Barbanti, Scott Lim, Ivandito Kuntjoro, Mohamed Abdel-Wahab, Antonio ColomboAbstractBackgroundTranscatheter aortic valve replacement (TAVR) is the gold-standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. T...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Patient – prosthesis mismatch Patient – prosthesis mismatch is often noted in aortic position, that too after surgery for aortic stenosis. In aortic stenosis the aortic root is not dilated and the left ventricle is hypertrophied. Hence often a lower size of prosthetic valve has to be chosen, which can lead to patient – prosthesis mismatch. In aortic regurgitation, a dilated aortic root often allows a good sized prosthesis to be chosen. To put it simply, a prosthetic valve too small for the patient’s body surface area produces patient-prosthesis mismatch. It produces an increase in transvalvar gradie...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Source Type: blogs
An 81-year-old woman was hospitalized for heart failure (HF) with severe aortic stenosis (AS). She had a history of liver transplantation under immunosuppressive therapy and multiple comorbidities. Our heart team considered her as a candidate for transcatheter aortic valve implantation (TAVI). Pre-screening multidetector computed tomography revealed the presence of a bulky calcification on the aortic root (Panel A). Therefore, a self-expandable transcatheter heart valve [THV; 26-mm CoreValve Evolut-R (Medtronic, USA)] was implanted via the femoral artery after balloon pre-dilatation (Panels B andC). Haemodynamic measuremen...
Source: European Heart Journal - Category: Cardiology Source Type: research
Authors: Demir OM, Ruparelia N, Frame A, Sen S, Mikhail GW, Fertleman M, Malik IS Abstract INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of symptomatic aortic stenosis. The number of TAVR procedures is expected to increase exponentially in the next decade. Therefore, patients will inevitably present with signs and symptoms attributable to TAVR bioprosthesis failure many years after an acutely successful procedure. Their management will become increasing important moving forward. Areas covered: The aim of this article is to review the causes of bioprosthesis failure and...
Source: Expert Review of Medical Devices - Category: Medical Devices Tags: Expert Rev Med Devices Source Type: research
An 87year-old female with symptomatic severe aortic stenosis underwent transcatheter valve replacement (TAVR) via the transfemoral approach with a 29mm self-expanding device. Moderate to severe paravalvular regurgitation led to the development of congestive heart failure and hospital readmission one month following TAVR. A second 29mm valve was placed to abolish the paravalvular regurgitation. Routine follow-up computed tomography (CT) imaging demonstrated leaflet thickening and decreased leaflet mobility suggesting valve thrombosis, despite adherence to Factor Xa inhibitor.
Source: Cardiovascular Revascularization Medicine - Category: Cardiology Authors: Source Type: research
Authors: Yanagisawa R, Hayashida K, Jinzaki M, Fukuda K Abstract An 84-year-old man with symptomatic severe aortic stenosis received transcatheter aortic valve implantation (TAVI). Dual-antiplatelet therapy was continued for 6 months post TAVI, and aspirin alone was used thereafter. Four-dimensional multidetector computed tomography revealed a new hypoattenuated leaflet thickening (HALT) with reduced leaflet motion at 1 year, considered to indicate leaflet thrombosis. At the 2-year follow-up, leaflet mobility had improved, with spontaneous regression of HALT. This is the first report of confirmed spontaneous regres...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
An 86-year-old woman was hospitalized for rapidly progressive dyspnoea, severe sepsis, and initial echocardiographic signs of biventricular cardiac decompensation. The patient had a history of transcatheter aortic valve replacement (TAVR) 1.5 years ago due to severe aortic stenosis (26  mm CoreValve Evolut R, Medtronic, Minneapolis, Minnesota, USA). For further evaluation, a contrast-enhanced multidetector computed tomography (MDCT) scan of the chest was performed. Multidetector computed tomography revealed a massive, free-floating thrombus in the ascending aorta arising from th e TAVR (Panel A andB). On cross-secti...
Source: European Heart Journal - Category: Cardiology Source Type: research
Introduction: Transcatheter aortic valve implantation (TAVI) is an established treatment for symptomatic aortic stenosis among elderly patients whose surgical complication risk seems to be high. Till now about 150.000 or more TAVI procedures have been performed worldwide but little is known of the occurrence of valve thrombosis following TAVI and its therapy.
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Source Type: research
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