Imaging for structural heart procedures: focus on computed tomography

Abstract

The success and continued rapid clinical integration of transcatheter valve technologies relies on imaging modalities to guide safe and effective device deployment. In particular, cardiac imaging, using both echocardiography and CT, is an integral resource for the multidisciplinary team. These modalities can provide valuable insight for the proceduralist at each stage of transcatheter-based valve insertion, as they can be used reliably to define the anatomy of interest and its relationship to surrounding structures, determine accurate device sizing, assess patients for valve-in-valve procedures, and screen for adverse features or procedural contraindications. We provide an overview of some of the key aspects of the use of CT and echocardiography in the context of transcatheter aortic valve replacement (TAVR), as well as transcatheter mitral valve replacement (TMVR).

Role of imaging in novel mitral technologies—echocardiography and computed tomography

“…Lifelike, 4DCT cinematic rendering may be more useful compared to traditional 3D volumetric reconstructions. CT is indispensable for mitral annulus sizing and for the prediction and evaluation of LVOT obstruction risk in TMVR ( Figure 3, Video 2) (10,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Additionally, CT allows precise measurement of the geometric mitral valve area, predicts optimal fluoroscopic angles and identifies the location of the coronary sinus in relation with the annulus (Figure 4).…”

“…(IV) TMVR relies on both echocardiography and CT, which are critical for patient selection, complete anatomic definition of the mitral complex, prediction of LVOT obstruction and complications diagnosis. Echocardiography is essential for procedural guidance (18,19,21,24,26,(33)(34)(35).…”

More than numbers: preprocedural multislice computed tomography analysis in a patient undergoing transcatheter aortic valve implantation

“…Multislice computed tomography (MSCT) has emerged as an integral part of patient evaluation to ensure adequate sizing, to assess surgical risk and to enable appropriate valve selection for optimal clinical results in patients undergoing transcatheter aortic valve implantation (TAVI) 1–4. Beyond sizing, MSCT scans are especially helpful in challenging anatomies to provide accurate dimensions, highlight potential pitfalls and avoid harmful, unexpected events during the implanting procedure.…”