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2017 ; 9
(Suppl 4
): S289-S298
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Standard imaging techniques in transcatheter aortic valve replacement
#MMPMID28540072
Salemi A
; Worku BM
J Thorac Dis
2017[Apr]; 9
(Suppl 4
): S289-S298
PMID28540072
show ga
Transcatheter aortic valve replacement (TAVR) has become a widely accepted
therapeutic option for patients with severe, symptomatic aortic stenosis at
intermediate, high, or extreme risk for conventional surgery as determined
through a heart team approach. Two valve prostheses are currently available and
the Food and Drug Administration (FDA) approved in the United States for TAVR:
the self-expandable Medtronic CoreValve (Medtronic, Inc., Minneapolis, MN, USA)
and the balloon-expandable Edwards Sapien Valve (Edwards Lifesciences, Irvine CA,
USA). The preoperative evaluation for TAVR includes transthoracic
echocardiography (TTE) for the diagnosis of aortic stenosis. Cardiac computed
tomography (CTA) has become the imaging modality of choice for annular sizing.
Aortic root dimensions and coronary ostia height, and the degree of annular and
left ventricular outflow tract calcification are also assessed to estimate the
risk of coronary obstruction, annular rupture, and postoperative aortic
regurgitation. Finally, CTA is essential to determine the adequacy of the
peripheral vasculature for a transfemoral approach. Intraoperatively, fluoroscopy
is mandatory for valve positioning, whereas the use of TTE or transesophageal
echocardiography (TEE) varies by center. TTE is used for postoperative
surveillance of valve function.