Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Imaging. 2011 Apr;4(4):416-29. doi: 10.1016/j.jcmg.2011.01.014.
Aortic stenosis is a common disorder. Aortic valve replacement is indicated in symptomatic patients with severe aortic stenosis, as the prognosis of untreated patients is poor. Nevertheless, many patients pose a prohibitively high surgical risk and are not candidates for surgical valve replacement. Transcatheter aortic valve implantation (TAVI) is a novel method to treat selected high-risk patients with aortic stenosis. Patient screening and anatomic measurements of the aortic root are of great importance to ensure procedural success and appropriate patient selection. Multidetector computed tomography (CT) is playing an increasingly important role in patient screening protocols before TAVI, provides detailed anatomic assessment of the aortic root and valve annulus, assesses the suitability of iliofemoral access, and determines appropriate coaxial angles to optimize the valve implantation procedure. Additionally, CT is providing a greater understanding of medium-term valve durability and integrity. This review outlines an evolving role for CT angiography in support of a TAVI program and describe step by step how CT can be used to enhance the procedure and provide a practical guide for the utilization of CT angiography in support of a transcatheter aortic valve program.
主动脉瓣狭窄是一种常见疾病。对于有症状的重度主动脉瓣狭窄患者，主动脉瓣置换术是指征，因为未经治疗的患者预后较差。然而，许多患者的手术风险极高，不适合进行外科瓣膜置换术。经导管主动脉瓣植入术（TAVI）是一种治疗特定高危主动脉瓣狭窄患者的新方法。患者筛选和主动脉根部的解剖测量对于确保手术成功和适当的患者选择非常重要。多排 CT（CT）在 TAVI 前的患者筛选方案中发挥着越来越重要的作用，提供了主动脉根部和瓣环的详细解剖评估，评估了髂股入路的适宜性，并确定了适当的同轴角度以优化瓣膜植入过程。此外，CT 还提供了对中期瓣膜耐久性和完整性的更深入了解。这篇综述概述了 CT 血管造影在支持 TAVI 项目中的不断发展的作用，并逐步描述了如何使用 CT 增强该过程，并为支持经导管主动脉瓣程序的 CT 血管造影的使用提供实用指南。
