Columbia University Medical Center, New York Presbyterian Hospital, New York, New York 10032, USA.
Curr Opin Cardiol. 2013 Sep;28(5):512-7. doi: 10.1097/HCO.0b013e3283632b5e.
Transcatheter aortic valve replacement (TAVR) has recently emerged as an alternative to surgical aortic valve replacement for patients with severe, symptomatic aortic stenosis who are at a 'high risk' or deemed inoperable. Multiple imaging modalities are integral to procedural success and recent studies may help establish the role of each modality.
Procedural guidance includes preimplantation device selection, intraprocedural guidance of valve positioning and post-implantation assessment of procedural success. Numerous studies have suggested that three-dimensional (3D) assessment of the aortic annulus and adjacent structures by multislice computed tomography (MSCT) or cardiac MRI can improve annular sizing and reduce complications. Subsequent studies suggest that 3D transesophageal echocardiography (TEE) can also accurately measure the annular aortic annulus. New imaging techniques help with coaxial fluoroscopic positioning. Finally, the use of intraprocedural TEE allows imaging of complications.
Multimodality imaging is indispensable for procedural guidance during TAVR. MSCT is a fundamental part of preprocedural planning, including the assessment of peripheral vasculature, the aortic root and the annulus and optimal fluoroscopic positioning. Echocardiography, particularly two-dimensional (2D) and 3D TEE, is an integral part of preprocedural, intraprocedural and immediate postprocedural assessment. MRI remains at this time an adjunctive imaging modality for procedural guidance, but may have an essential role in postprocedural valve assessment.
经导管主动脉瓣置换术（TAVR）已成为严重症状性主动脉瓣狭窄患者的一种替代手术治疗方法，这些患者具有“高危”或手术不可行特征。多种影像学方法对于手术成功至关重要，近期的研究可能有助于确定每种方法的作用。
程序指导包括植入前装置选择、瓣膜定位的术中指导以及植入后的程序成功评估。许多研究表明，多层螺旋 CT（MSCT）或心脏 MRI 对主动脉瓣环和相邻结构的三维（3D）评估可以改善瓣环尺寸并减少并发症。随后的研究表明，3D 经食管超声心动图（TEE）也可以准确测量瓣环。新的成像技术有助于同轴荧光透视定位。最后，术中 TEE 的使用可以对并发症进行成像。
多模态成像对于 TAVR 期间的程序指导是不可或缺的。MSCT 是术前规划的基本组成部分，包括外周血管、主动脉根部和瓣环的评估以及最佳的荧光透视定位。超声心动图，特别是二维（2D）和 3D TEE，是术前、术中和即刻术后评估的重要组成部分。目前，MRI 仍然是一种辅助的程序指导成像方式，但在术后瓣膜评估中可能具有重要作用。
