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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EFor patients with severe aortic stenosis, open-heart surgical valve replacement remains the current clinical standard with excellent long-term outcomes [Schoenhagen P et al. \u003Cem\u003EJ Cardiovasc Comput Tomogr\u003C\/em\u003E 2011]. For those with severe aortic stenosis who are considered too high risk for the traditional approach, transcatheter aortic valve implantation (TAVI) has proven to be a viable treatment option [Sinning JM et al. \u003Cem\u003EMethodist Debakey Cardiovasc J\u003C\/em\u003E 2012]. This article discusses the use of aortic multislice computed tomography for TAVI screening.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFor patients with severe aortic stenosis, open-heart surgical valve replacement remains the current clinical standard with excellent long-term outcomes [Schoenhagen P et al. \u003Cem\u003EJ Cardiovasc Comput Tomogr\u003C\/em\u003E 2011]. For those with severe aortic stenosis who are considered too high risk for the traditional approach, transcatheter aortic valve implantation (TAVI) has proven to be a viable treatment option [Sinning JM et al. \u003Cem\u003EMethodist Debakey Cardiovasc J\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EWith the traditional surgical approach, direct inspection of the valve is possible [Ewe SH et al. \u003Cem\u003EInt J Cardiovasc Imaging\u003C\/em\u003E 2011]. However, transcatheter valvular procedures are characterized by lack of exposure of the operative field [Schoenhagen P et al. \u003Cem\u003EJ Cardiovasc Comput Tomogr\u003C\/em\u003E 2011]. This makes preprocedural imaging of the anatomy of the aortic or mitral valve and their spatial relationships crucial to select the most appropriate device or prosthesis and plan the percutaneous procedure [Ewe SH et al. \u003Cem\u003EInt J Cardiovasc Imaging\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EBernard Chevalier, MD, Institut Cardiovasculaire Paris Sud (ICPS), Massy, France, discussed the use of aortic multislice computed tomography (MSCT) for TAVI screening. Topics covered included the CT scan, aorta, coronary ostia, bicuspidity, aortic calcification, aortic valve area, the annulus plan for view selection during TAVI, annulus size, and the actual shapes of the annulus and crown. He emphasized how echocardiography only shows the anteroposterior diameter and the potential for error if this measurement alone is used. He described how echocardiography is not isotopic compared with the CT scan (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Resolution with echocardiography is less than that of a CT scan, with a lower depth resolution and an inability to cover a large diameter. Conversely, CT scans are 3D and isotropic, with a 0.5-mm resolution in all directions. These features may help determine the optimal view, said Prof. Chevalier.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Echocardiography Is Not Isotropic.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1318929073\u0022 data-figure-caption=\u0022Echocardiography Is Not Isotropic.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/8\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12768\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EEchocardiography Is Not Isotropic.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from B. Chevalier, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Chevalier also highlighted the clinical impact of moderate- to high-grade aortic regurgitation (AR) and described the ICPS experience with AR, annulus sizing, and predictors of AR \u22652. Aortic valve regurgitation has been considered a potential contributor to morbidity and mortality after TAVI. The reported prevalence of moderate and severe AR after TAVI is 6% to 21%, which is considerably higher than after a surgical valve replacement [Gotzmann M et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2012]. Among 175 ICPS patients, post-TAVI aortic regurgitation \u22652 occurred in significantly fewer patients whose surgery was CT-guided (n=27; 15.4%) as opposed to transesophageal echocardiography (TEE)-guided (n=42; 24%; p=0.04).\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EProcedural Success\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPires de Morais et al. [\u003Cem\u003ERev Port Cardiol\u003C\/em\u003E 2011] used MSCT to select candidates for transcatheter aortic valve replacement, procedural support, and postinterventional follow-up. The authors found MSCT to be an essential imaging tool in the selection and exclusion of candidates for TAVI; the evaluation of coronary anatomy and the relationship of the coronary ostia with the aortic valve structure; and the accurate analysis of the valve annulus and aortic root, left ventricular outflow tract, aorta, and peripheral vascular access routes. They also described MSCT as central to the choice of appropriate prosthesis size.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EProcedural success depends on precise valve positioning in the 3D space of the aortic annulus and root [Gurvitch R et al. \u003Cem\u003EJ Am Coll Cardiol Intv\u003C\/em\u003E 2010]. Incorrect positioning may result in valve embolization, severe aortic regurgitation, coronary obstruction, heart block, or impaired left ventricular function.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EMSCT has shown utility in TAVI [Wood DA et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2009; Tops LF et al. \u003Cem\u003EJ Am Coll Cardiol Img\u003C\/em\u003E 2008; Ng AC et al. \u003Cem\u003ECirc Cardiovasc Imaging\u003C\/em\u003E 2010]. Prof. Chevalier reports high resolution (0.5 mm) in the 3 axes (X, Y, Z), and true 3D imaging that is optimal for calcified structures and prosthetic materials.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFeuchtner et al. [\u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2006] found that the approach may not only be useful in quantifying valve calcification but also in determining aortic valve area. According to Choo and Steeds [\u003Cem\u003EBr J Radiol\u003C\/em\u003E 2011], MSCT is developing a particularly prominent role in planning TAVI, where it can deliver accurate measurements of the extent of calcification, as well as the annulus and the angulation between the left ventricular apex and the aortic root.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EGurvitch et al. [\u003Cem\u003EJ Am Coll Cardiol Intv\u003C\/em\u003E 2010] assessed whether MSCT could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation in 20 patients who underwent MSCT before TAVI. Outcomes showed that preprocedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or \u201cline of perpendicularity\u201d can be generated, improving the accuracy of valve deployment and outcomes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMultislice Computed Tomography and the Aortic Annulus\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EIn a study comparing transthoracic echocardiography or TEE measurement of the annulus, MSCT identified that the aortic annulus was commonly eccentric and often oval [Wood DA et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAccording to Prof. Chevalier, accurate knowledge of the size of the annulus is very important: overestimation risks annulus rupture and possible valve dysfunction; underestimation increases the risks of embolization and AR. He reminded the audience that the annulus is a crown with 3 branches, and the crown is not circular. It has a variable orientation (\u226430 degrees), a small diameter that is often anteroposterior, a large diameter that is grossly lateral, and variability between the 2 diameters (4 to 5 mm, and 1 to 8 mm).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/8\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznacd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznacd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}