Ali Alshahrani, Sean O’Nunain
Aortic Stenosis (AS) is by far the most prevalent form of VHD in the elderly. The contemporary etiologies of AS are due to degenerative mechanisms rather than rheumatic diseases, especially in the western world. Transcatheter aortic valve implantation (TAVI) has evolved dramatically as an alternative treatment to surgical aortic valve replacement (SAVR) in patients with severe AS. The fast development of TAVI can be linked to the rising competence of interventionists and the improvements in technology and imaging techniques.
In order for the TAVI procedure to be successful, multiple imaging modalities (TTE/TEE, MDCT, etc.) must be utilized. These imaging modalities are utilized for a variety of purposes, including but not limited to guiding pre and post-procedural evaluation and planning, intra-procedural imaging, and follow up. Both patient and implant selections greatly depend on a thorough pre procedural evaluation of the aortic valve structure, ascending aorta, and vascular access. The use of 2D TEE has been superseded by 3D TEE which offers better measurement planes and tissue resolution.
There is accumulating scientific data supporting the immense importance of MDCT among other imaging modalities in evaluating the anatomy, access appropriateness, and determining optimal coaxial angles for measurement. In post-procedure imaging, MDCT is also useful for evaluating valve position and functionality. This review summarizes the main elements of the TAVI procedure and the use of various imaging modalities. In addition to discussing the role of these modalities in minimizing procedural complications and optimizing TAVI outcomes.
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