Skip to main content
SpringerLink
Log in

Bildgebung vor Transkatheteraortenklappenersatz

Imaging prior to transcatheter aortic valve implantation

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Der perkutane, kathetergestützte Aortenklappenersatz („transcatheter aortic valve implantation“, TAVI) ist eine etablierte Alternative für Patienten mit schwerer Aortenklappenstenose (AS), wenn sie wegen Komorbiditäten und damit verbundenem hohem perioperativem Risiko oder Kontraindikationen für einen konventionellen, offen-chirurgischen Aortenklappenersatz nicht geeignet sind. Für eine adäquate Indikationsstellung, Prothesenwahl und Prothesengrößenbestimmung und somit für eine Verminderung periinterventioneller Komplikationen spielt die präprozedurale Bildgebung eine entscheidende Rolle. Neben der Dopplerechokardiographie, die v. a. für die Graduierung der AS und die periinterventionelle Bildgebung genutzt wird, nimmt die Computertomographie eine hervorgehobene Stellung ein. Mit ihr kann nicht nur die komplexe dreidimensionale Geometrie des Aortenbulbus, sondern auch der Aorta und der peripheren Gefäße als potenzielle Zugangswege zuverlässig beurteilt und vermessen werden.

Abstract

Percutaneous transcatheter aortic valve implantation (TAVI) is an established alternative to open heart surgery in patients with severe aortic stenosis (AS) unsuitable for conventional aortic valve replacement due to comorbidities with a high perioperative risk or contraindications. Preprocedural imaging plays a major role for adequate determination of indications and prosthesis selection, prosthesis sizing and therefore for a reduction of periprocedural complications. Besides Doppler echocardiography which is mainly used for grading of the severity of aortic valve stenosis and peri-interventional imaging, cardiac computed tomography (CCT) is the imaging modality of choice. The CCT procedure not only allows for reliably assessment and measuring of the complex 3-dimensional geometry of the aortic root but also for the aorta and the peripheral vessels used as potential access paths.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Cribier A, Eltchaninoff H, Bash A et al (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 06(24):3006–3008

    Article  Google Scholar 

  2. Leon MB, Smith CR, Mack M et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    Article  PubMed  CAS  Google Scholar 

  3. Grube E, Schuler G, Buellesfeld L et al (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50:69–76

    Article  PubMed  Google Scholar 

  4. Tamburino C, Capodanno D, Ramondo A et al (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123:299–308

    Article  PubMed  Google Scholar 

  5. Abdel-Wahab M, Zahn R, Horack M et al (2011) Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart 97(11):899–906

    Article  PubMed  Google Scholar 

  6. Holmes DR, Mack MJ, Kaul S et al (2012) 2012 ACCF/AATS/SCAI/STS Expert consensus document on transcatheter aortic valve replacement: developed in collaboration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery. Heart Failu Ann Thorac Surg 93(4):1340–1395

    Article  Google Scholar 

  7. Achenbach S, Delgado V, Hausleiter J et al (2012) SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 6(6):366–380

    Article  PubMed  Google Scholar 

  8. Husser O, Holzamer A, Resch M et al (2013) Prosthesis sizing for transcatheter aortic valve implantation – comparison of three dimensional transesophageal echocardiography with multislice computed tomography. Int J Cardiol pii:S0167–5273

    Google Scholar 

  9. Little SH, Shah DJ, Mahmarian JJ (2012) Multimodality noninvasive imaging for transcatheter aortic valve implantation. A Primer. Methodist DeBakey Cardiovasc J 8(2):29–37

    PubMed  Google Scholar 

  10. Haensig M, Lehmkuhl L, Rastan AJ et al (2012) Aortic valve calcium scoring is a predictor of significant paravalvuläre aortic insufficiency in transapical-aortic valve implantation. Eur J Cardiothorac Surg 41(6):1234–1240 (discussion 1240–1241)

    Article  PubMed  Google Scholar 

  11. American College of Cardiology Foundation Task Force on Expert Consensus Documents, Hundley WG, Bluemke DA et al (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardio- vascular magnetic resonance: a report of the American college of cardiology foundation task force on expert consensus documents. J Am Coll Cardiol 55(23):2614–2662

    Article  Google Scholar 

  12. Achenbach S, Barkhausen J, Beer M et al (2012) Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging. Rofo 184(4)

  13. Gutberlet M, Abdul-Khaliq H, Stobbe H et al (2001) The use of cross-sectional imaging modalities in the diagnosis of heart valve diseases. Z Kardiol 90(Suppl 6):2–12

    Article  PubMed  Google Scholar 

  14. Kühne T, Weiss S, Brinkert F et al (2004) Catheter visualization with resonant markers at MR imaging-guided deployment of endovascular stents in swine. Radiology 233(3):774–780

    Article  Google Scholar 

  15. Kahlert P, Parohl N, Albert J et al (2012) Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine. J Cardiovasc Magn Reson 14:21

    Article  PubMed  Google Scholar 

  16. Toggweiler S, Leipsic J, Binder RK et al (2013) Management of vascular access in transcatheter aortic valve replacement: part 1: basic anatomy, imaging, sheaths, wires, and access routes. JACC Cardiovasc Interv 6(7):643–653

    Article  PubMed  Google Scholar 

  17. Gutberlet M, Abdul-Khaliq H, Grothoff M et al (2003) [Evaluation of left ventricular volumes in patients with congenital heart disease and abnormal left ventricular geometry. Comparison of MRI and transthoracic 3-dimensional echocardiography]. Rofo 175(7):942–951

    Article  PubMed  CAS  Google Scholar 

  18. Fairbairn TA, Steadman CD, Mather AN et al (2013) Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart 99(16):1185–1191

    Article  PubMed  Google Scholar 

  19. American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions et al (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of cardiovascular anesthesiologists: endorsed by the Society for cardiovascular angiography and interventions and the Society of thoracic surgeons. Circulation 114(5):e84–e231

    Article  Google Scholar 

  20. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496

    Article  Google Scholar 

  21. Lehmkuhl L, Foldyna B, Von Aspern K et al (2013) Inter-individual variance and cardiac cycle dependency of aortic root dimensions and shape as assessed by ECG-gated multi-slice computed tomography in patients with severe aortic stenosis prior to transcatheter aortic valve implantation: is it crucial for. Int J Cardiovasc Imaging 29(3):693–703

    Article  PubMed  Google Scholar 

  22. Tops LF, Wood DA, Delgado V et al (2008) Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 1(3):321–330

    Article  PubMed  Google Scholar 

  23. Masson JB, Kovac J, Schuler G et al (2009) Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv 2(9):811–820

    Article  PubMed  Google Scholar 

  24. Généreux P, Head SJ, Van Mieghem NM et al (2012) Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol 59(25):2317–2326

    Article  PubMed  Google Scholar 

  25. Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832

    Article  PubMed  CAS  Google Scholar 

  26. Tzikas A, Schultz C, Van Mieghem NM et al (2010) Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography: validation of a prototype software. Catheter Cardiovasc Interv 76(4):602–607

    Article  PubMed  Google Scholar 

  27. Smith CR, Leon MB, Mack MJ et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    Article  PubMed  CAS  Google Scholar 

  28. Toggweiler S, Gurvitch R, Leipsic J et al (2012) Percutaneous aortic valve replacement: vascular outcomes with a fully percutaneous procedure. J Am Coll Cardiol 59(2):113–118

    Article  PubMed  Google Scholar 

  29. Lehmkuhl L, Foldyna B, Haensig M et al (2013) Stellenwert der präprozeduralen Computertomographie bei kathetergestützter Aortenklappenimplantation. Rofo 185:1–9

    Article  Google Scholar 

  30. Wuest W, Anders K, Schuhbaeck A et al (2012) Dual source multidetector CT-angiography before transcatheter aortic valve implantation (TAVI) using a high-pitch spiral acquisition mode. Eur Radiol 22(1):51–58

    Article  PubMed  CAS  Google Scholar 

  31. Buser M, Jeger R, Kaiser C et al (2012) Schwere symptomatische Aortenstenose – Therapiemöglichkeiten im Zeitalter der interventionellen Klappenimplantation. Schweiz Med Forum 12(14–15):304–309

    Google Scholar 

  32. Binder RK, Webb JG, Willson AB et al (2013) The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol 62(5):431–438

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. Die Autoren M. Gutberlet, L. Lehmkuhl und B. Foldyna haben Vortragshonorare von der Fa. Siemens erhalten. M. Grothoff, C. Lücke, F. Riese, S. Nitzsche, M. Haensig, K. v. Aspern, D. Holzhey, H. Thiele, G. Schuler, A. Linke, F.-W. Mohr geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung für Diagnostische und Interventionelle Radiologie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    M. Gutberlet, B. Foldyna, M. Grothoff, C. Lücke, F. Riese, S. Nitzsche & L. Lehmkuhl

  2. Abteilung für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland

    M. Haensig, K. von Aspern, D. Holzhey & F.-W. Mohr

  3. Abteilung für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland

    H. Thiele, G. Schuler & A. Linke

Authors
  1. M. Gutberlet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Foldyna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Grothoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Lücke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Riese
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Nitzsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Haensig
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. von Aspern
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Holzhey
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. G. Schuler
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Linke
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. F.-W. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. L. Lehmkuhl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Gutberlet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gutberlet, M., Foldyna, B., Grothoff, M. et al. Bildgebung vor Transkatheteraortenklappenersatz. Radiologe 53, 886–895 (2013). https://doi.org/10.1007/s00117-012-2472-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-012-2472-3

Schlüsselwörter

Keywords

Search

Navigation