Three-dimensional imaging of the aortic valve geometry for prosthesis sizing prior to transcatheter aortic valve replacement

Abstract

Transcatheter aortic valve replacement (TAVR) is established as an alternative treatment option in patients with symptomatic aortic valve stenosis at high risk for cardiovascular surgery and has shown superiority over conservative management in inoperable patients [ 1 Leon M.B. Smith C.R. Mack M. et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363: 1597-1607 Crossref PubMed Scopus (5333) Google Scholar , 2 Smith C.R. Leon M.B. Mack M.J. et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011; 364: 2187-2198 Crossref PubMed Scopus (4669) Google Scholar ]. Noninvasive imaging of the aortic valve (AV) geometry plays a central role in TAVR because accurate determination of aortic annular diameters is crucial for appropriate prosthesis sizing [ 3 Genereux P. Head S.J. Wood D.A. et al. Transcatheter aortic valve implantation: 10-year anniversary part II: clinical implications. Eur Heart J. 2012; 33: 2399-2402 Crossref PubMed Scopus (46) Google Scholar , 4 Genereux P. Head S.J. Wood D.A. et al. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J. 2012; 33: 2388-2398 Crossref PubMed Scopus (121) Google Scholar , 5 Jilaihawi H. Chin D. Spyt T. et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis. Eur Heart J. 2010; 31: 857-864 Crossref PubMed Scopus (108) Google Scholar ]. Current guidelines define multislice computed tomography (MSCT) with three-dimensional (3D) reconstruction of aortic root geometry as the gold standard for pre-procedural patient selection despite MSCT inherits important limitations [ [8] Sinning J.M. Ghanem A. Steinhauser H. et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2010; 3: 1141-1149 Abstract Full Text Full Text PDF PubMed Scopus (236) Google Scholar ].