Computed Tomography Imaging In The Context Of Transcatheter Aortic Valve Implantation (TAVI) / Transcatheter Aortic Valve Replacement (TAVR)

While facilitated or semi-automated workflows may be used, the interpreter analyzing the imaging must be able to confirm the accuracy of the generated annular plane and perform manual corrections if required.

Systolic measurements are preferred for measurement and calculation of device sizing.

Area and perimeter measurements are preferred for sizing of the aortic annulus over isolated 2 dimensional measurements and should be provided in the report.

Number of cusps should be stated, and if a bicuspid valve is present, its morphology should be classified.

The presence of a median raphe and the absence/presence of calcification of this should be mentioned.

The aortic annulus size should be measured and reported in bicuspid aortic valves as for tricuspid aortic valves.

Pre-TAVI/TAVR CT assessement should include coronary height, mean SOV diameter, and STJ height and diameter.

Coronary ostial distance from aortic annulus should be measured in a perpendicular fashion from the established annular plane.

Provision of optimal fluoroscopic projection angulations based on CT for each individual patient should be considered.

If the patient is not positioned supine for the CT examination, this should be noted in the report and proposed fluoroscopic angles should not be provided.

While facilitated or semi-automated work-flows may be used, the interpreter analyzing the imaging must be able to confirm the accuracy of the generated vessel centerline and perform manual corrections if required.

The minimal luminal diameter along both the right and left iliofemoral system should be provided including the anatomical location to the level of the expected puncture site.

All areas of >270° calcification in the iliofemoral arteries should be reported.

Calcification located anteriorly at the site of probable puncture should be reported.

The report should include a clear description of all vascular pathologies including aneurysms, dissection, and occlusions.

Reporting of the coronary arteries for severity of coronary artery disease can be considered in appropriately selected patients, if image quality is of diagnostic quality.

The presence and course of anomalous coronary arteries should be reported.

CT images should be reviewed for incidental findings.

Extracardiac findings should be reviewed and reported in the context of the healthcare environment and health status of the patient.

Significant findings should be included in the dictated report and when appropriate verbally communicated to the Heart team.

At present, routine CT imaging following TAVI/TAVR is not recommended.

CT should be considered in the setting of clinical concern for valve thrombosis, infective endocarditis, or structural valve degeneration.

Leaflet thickening should be described based on location, extent in length and overall thickness.

Restricted motion should be reported as present or absent.

When available the size of the surgical valve in situ should be obtained from the patient records. When this is not possible, internal diameter may be measured and used for calculating the valve to be inserted.

The relationship of the uppermost aspect of the surgical valve struts to the STJ and to the coronaries should be described.

When the surgical valve struts end below the level of the coronary ostia, virtual transcatheter valve to coronary ostia distances do not need to be measured.

Stentless surgical valve in valve procedures should be interpreted and reported as for native TAVI/TAVR cases regarding risk of coronary occlusion.