TAVI imaging: over the echocardiography
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CARDIAC RADIOLOGY
TAVI imaging: over the echocardiography Ludovico La Grutta1 · Patrizia Toia2 · Emanuele Grassedonio2 · Salvatore Pasta3 · Domenico Albano2,4 · Francesco Agnello2 · Erica Maffei5 · Filippo Cademartiri5,6 · Tommaso Vincenzo Bartolotta2,7 · Massimo Galia2 · Massimo Midiri2 Received: 5 June 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract Aortic valve stenosis (AS) is a common valvular heart disease. Recently, transcatheter aortic valve implantation (TAVI) has changed the treatment of severe AS in elderly patients with contraindications to traditional surgical replacement. Echocardiography is conventionally used as the first imaging modality to assess the presence and severity of AS and to provide anatomical and functional information. Nowadays, imaging techniques play a crucial role in the planning of TAVI to define suitable candidates. Computed tomography (CT) is essential to display the anatomy of the aortic valve complex (including aortic annulus, Valsalva sinuses, coronary arteries ostia, sinotubular junction), thoracoabdominal aorta, and vascular access. Cardiac CT may also provide the evaluation of coronary arteries in alternative to conventional coronary angiography. Magnetic resonance imaging may be alternative or supplementary in selected cases, providing detailed information of cardiac function and myocardial wall characteristics. More recently, advanced computer modeling image-based techniques can be used to support the evaluation of the feasibility and safety of TAVI procedures. Keywords Aortic valve stenosis · Computed tomography · Magnetic resonance imaging · Transcatheter aortic valve implantation
Introduction
* Ludovico La Grutta [email protected]; [email protected] 1
Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (ProMISE), University of Palermo, A.O.U.P. Giaccone, Via del Vespro 127, Palermo, Italy
2
Department of Biomedicine, Neuroscience and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
3
Department of Engineering, University of Palermo, Palermo, Italy
4
IRCCS – Istituto Ortopedico Galeazzi, Milan, Italy
5
Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
6
Cardiovascular Imaging Unit, SDN Foundation IRCCS, Naples, Italy
7
Department of Radiology, Fondazione Istituto Giuseppe Giglio Cefalù, Cefalù, Italy
Aortic valve stenosis (AS) is the most common valvular heart disease (VHD) accounting for about 35% of moderate to severe native AS [1]. The AS presents an estimated prevalence of 7.6 million among adults > 75 years of age in North America and Europe [2]. The prevalence of AS is expected to increase in the future due to the aging population. Patients with severe symptoms are often associated with a poor outcome because of ineffective medical therapy unless a valve replacement is performed. Traditional opensurgery or transcatheter aortic valve implantation (TAVI), also termed TAVR (transcatheter ao
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