Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Abstract

In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist

“…MSCT provides accurate data for sizing devices for TAVR ( Figure 1C) and LAA occlusion ( Figure 3A-D). 2 Before a TAVR procedure, the diameters, areas and perimeters of the aortic annulus, sinuses of Valsalva and ascending aorta can be accurately determined. In addition, the location and distance of the coronary artery ostia from the aortic valve and bypass grafts can reliably be visualised.…”

“…Three-dimensional transoesophageal echocardiography (TOE) and multi-slice computed tomography (MSCT) provide precise pre-treatment information on anatomic abnormalities, the exact localisation of the cardiac pathology, its severity and precise anatomic dimensions of the lesion. 1,2 Such information facilitates procedural planning on the best ways to access and treat the SHD lesion.…”

Structural heart disease interventions

“…The success of the procedure rests on appropriate case selection, detailed pre and intra procedural imaging and knowledge and expertise of various techniques of device deployment, familiarity with the equipment, anticipation of complications and ways to deal with them. [1,2]. There is limited experience with cardiac magnetic resonance [CMR]; however, it is an attractive alternative imaging modality in pre and post procedural evaluation of SHD, particularly in patients with renal impairment and in patient with suboptimal echocardiographic window [3].…”