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Multi-modality Imaging of the Aortic Valve in the Era of Transcatheter Aortic Valve Replacement: a Guide for Patient Selection, Valve Selection, and Valve Delivery

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Abstract

Aortic stenosis is a common condition traditionally treated surgically. Transcatheter aortic valve replacement (TAVR) is an exciting and new method allowing treatment of high risk and inoperable patients. Multimodality imaging is extremely important in the preprocedural evaluation, the performance of the procedure, and the post-procedural assessment and includes transthoracic echocardiography, transesophageal echocardiography, conventional angiography, multi-detector computed tomography, and cardiac magnetic resonance. This paper will review the role of various imaging modalities during the phases of the TAVR procedure with an emphasis on the advantages and limitations of each approach.

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Authors and Affiliations

  1. Cardiac Catheterization Laboratories, University of Virginia Health System, Charlottesville, VA, USA

    Michael Ragosta

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  1. Michael Ragosta
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Correspondence to Michael Ragosta.

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Associate Editor Angela Taylor oversaw the review of this article

Electronic Supplementary Material

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This is an example of a deployment of the balloon expandable, Edwards Sapien valve. The valve is positioned carefully and is centered on the annulus imaged by aortography, and the valve is deployed during rapid ventricular pacing in order to prevent systolic ejection of the valve (AVI 23478 kb)

This is an example of the use of balloon valvuloplasty to size the annulus. Aortography is performed during inflation of an 18-mm balloon. Note that there is no regurgitation of contrast into the ventricle and also that there is little to no distance between the inflated 18-mm balloon and the aortic wall. In this case, the annulus and sinotubular junctions were deemed too small for a 23-mm Edwards prosthesis (AVI 37612 kb)

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Ragosta, M. Multi-modality Imaging of the Aortic Valve in the Era of Transcatheter Aortic Valve Replacement: a Guide for Patient Selection, Valve Selection, and Valve Delivery. J. of Cardiovasc. Trans. Res. 6, 665–674 (2013). https://doi.org/10.1007/s12265-013-9490-z

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  • DOI: https://doi.org/10.1007/s12265-013-9490-z

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