Al-Hassan D, Blanke P, Leipsic J
Department of Diagnostic Radiology King Fahd Military Medical Complex Dharan, Kingdom of Saudi Arabia -
Minerva Cardioangiol. 2013 Aug;61(4):407-27.
Degenerative calcific aortic stenosis represents the most common valve abnormality with increasing incidence in the elderly. Studies have shown that aortic stenosis is a fatal disease with a high cardiovascular death rate if untreated. However, many patients are encumbered with multiple comorbidities making them high-risk candidates for surgical aortic valve replacement, which is the hitorical treatment of choice. Transcatheter aortic valve implantation (TAVI) has seen rapid advancements over the last number of years with over 50000 TAVI procedures being performed in 40 countries with excellent prognosis proving TAVI to be a feasible alternative therapy to traditional surgical aortic valve replacement to treat high-risk patients. In addition to clinical suitability, imaging plays an essential role for optimal patient selection and to help select the appropriate prosthesis and to help reduce the likelihood of complications and adverse events. Fundamental to the procedure success, is the non-invasive assessment of the aortic annulus, the evaluation of the aortic root and the determination of the access to the aortic annulus. Among different imaging modalities that have been employed, multidetector computed tomography (MDCT) is increasingly used because of its capability of 3-dimentional (3D) determination of the non-circular nature of the aortic annulus as well as the complex aortic root anatomy. Additionally, MDCT provides a deep understanding of the structural integrity of the transcatheter aortic valve and enables the evaluation of the prosthesis location after TAVI and identification of post procedure complications. In this article, we discuss the current role of MDCT in pre-TAVI evaluation but also in the guidance of the procedure and in post-procedure follow-up.
退行性钙化性主动脉瓣狭窄是最常见的瓣膜异常，在老年人中的发病率不断上升。研究表明，主动脉瓣狭窄是一种致命疾病，若不治疗，心血管死亡率很高。然而，许多患者伴有多种合并症，这使他们成为外科主动脉瓣置换术的高危候选人，而外科主动脉瓣置换术是历来的首选治疗方法。在过去几年中，经导管主动脉瓣植入术（TAVI）取得了快速进展，40个国家已进行了超过50000例TAVI手术，预后良好，证明TAVI是治疗高危患者的传统外科主动脉瓣置换术的可行替代疗法。除了临床适用性外，影像学对于优化患者选择、帮助选择合适的假体以及降低并发症和不良事件的可能性起着至关重要的作用。手术成功的基础是对主动脉瓣环进行无创评估、评估主动脉根部以及确定进入主动脉瓣环的途径。在已采用的不同成像方式中，多排螺旋计算机断层扫描（MDCT）因其能够三维（3D）确定主动脉瓣环的非圆形性质以及复杂的主动脉根部解剖结构而越来越多地被使用。此外，MDCT能深入了解经导管主动脉瓣的结构完整性，并能在TAVI术后评估假体位置以及识别术后并发症。在本文中，我们讨论了MDCT在TAVI术前评估、手术指导及术后随访中的当前作用。
