Usefulness of Multidetector Computed Tomography Imaging Before Percutaneous Prosthetic Aortic Valve Implantation

Abstract

In patients with severe aortic stenosis (aortic valve area <1cm 2 or <0.6cm 2 /m 2 ) and high surgical risk (haemodynamic instability or significant co-morbidities), surgical aortic valve replacement is often rejected and, unfortunately, balloon valvuloplasty cannot provide a sustained improvement. Percutaneous heart valve (PHV) implantation is an excellent alternative treatment in such cases. The first successful human PHV implantation was performed in April 2002 by Cribier's group at Rouen University Hospital in France, via the antegrade (venous) transseptal approach. 1 Because of the complexity of the antegrade approach, several changes were introduced to implantation protocols. Subsequently, the arterial transfemoral and transapical delivery routes were developed. 2,3 The transapical approach is the most recently developed technique for transcatheter aortic valve replacement. This procedure involves a limited left lateral thoracotomy and requires a direct cardiac puncture and sheath Multidetector Computed Tomography Before Percutaneous Heart Valve Implantation CT works as a complement to echocardiography and conventional angiography. At our institution, the examination comprises two acquisitions: a cardiac assessment of the aortic valve immediately followed by abdominal and pelvic CT angiography, which is essential for assessing the retrograde route of the device. Other authors suggest performing only one acquisition. 5 AbstractPercutaneous implantation of an aortic valve has become a promising alternative treatment for patients with severe symptomatic aortic stenosis in whom conventional surgical treatment is contraindicated. A transfemoral or transapical delivery route can be chosen depending on the quality of vascular access and the type and size of prosthesis used. This article will mainly focus on the retrograde transfemoral approach, a technique with a high procedural success rate that is growing in popularity. Collaboration between radiologists and cardiologists is vital for a good outcome, and is mainly based on multidetector computed tomography (MDCT), which has quickly assumed a leading role in pre-implantation planning for inoperable severe aortic stenoses. The contribution of MDCT post-implantation is still under evaluation, but also seems promising. This article will discuss procedural techniques and clinical aspects of MDCT examination before and after percutaneous aortic valve implantation using the arterial transfemoral approach.