Multimodality imaging in transcatheter aortic valve implantation: comparison between cardiovascular magnetic resonance, cardiac computed tomography, transesophageal and transthoracic echocardiography

Erroneous Measurement of the Aortic Annular Diameter Using 2-Dimensional Echocardiography Resulting in Inappropriate CoreValve Size Selection

“…More recently, multislice computed tomography (CT) has emerged as an alternative and perhaps superior technique (4). CT provides a more reliable and detailed anatomical assessment of the aortic valvular complex and yields larger aortic annular diameters than echocardiography (5)(6)(7)(8)(9)(10)(11). Consequently, echocardiographic-based TAVR sizing may be inaccurate and may fail to provide the expected THV oversizing.…”

“…Consequently, echocardiographic-based TAVR sizing may be inaccurate and may fail to provide the expected THV oversizing. Supporting this hypothesis is the observation that the rates of both PVL and mortality decline with CT-based sizing (5)(6)(7)(8)(9)(10)(11). Although it is axiomatic that the superiority of CT-based sizing is achieved through more accurate adherence to manufacturer THV-oversizing principles, this hypothesis has not been corroborated.…”

The art of assessing aortic stenosis

“…CMR provides better anatomical information than echocardiography regarding the aorta and gives systematically larger and probably more accurate estimates for annulus size. The agreement between CMR and TTE on TAVI size selection in one study33 was only 14% (κ=−0.06) compared with 50% (κ=0.31) between MDCT and CMR. Paraprosthetic regurgitation was uncommon and was associated with large annulus size on CMR but not on TTE, which calls into question the significance of discrepancies between sizing by CMR and TTE.…”

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

“…21 Transcatheter aortic valve replacement (TAVR): post-procedural evaluation Following TAVR insertion, MDCT can be utilized to assess for accurate device positioning, in the intermediate to long-term follow-up period. 22 When assessing for TAVR positioning, a double oblique axial projection that is orthogonal to the aortic root is required to evaluate the expansion, circularity and apposition of the TAVR prosthesis. Additionally, implantation depth can be evaluated by a long-axis or coronal oblique view, assessing the margins of the prosthesis in relation to the native valve annulus and coronary arteries.…”