Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation.
Transcatheter aortic valve implantation (TAVI) without replacement requires precise knowledge of the anatomic dimensions and physical characteristics of the peripheral vasculature and aortic valve annulus at the insertion of the aortic valve leaflet and root at the level of the sinus of Valsalva. Multislice computed tomography (CT) allows detailed and precise assessment of the anatomic variables. Noncardiovascular structures are also amenable to assessment by CT. Of the 394 patients screened for TAVI, 259 (65.7%) had non-contrast CT to evaluate chest anatomy and contrast CT to evaluate ilio-femoral anatomy. Significant noncardiac findings were defined as those requiring immediate evaluation or intervention or additional clinical or radiologic follow-up. Noncardiovascular findings known before CT were not included. Of the 259 patients, 105 (40.5%) were men. The mean age was 82.3 +/- 8.1 years. New, significant noncardiovascular findings were found in 89 (34.3%) and malignancy in 11 (4.2%) patients. Insignificant noncardiovascular findings were identified in 222 patients (85.7%). Signs of fluid retention were noted on CT in 105 patients (40.5%), with pleural effusion in 100 (38.6%), ascites in 17 (6.5%), and pericardial effusion in 14 (5.4%). Important peripheral vascular disease was found in 98 patients (37.8%), resulting in exclusion of 49 (19.1%) from TAVI using the transfemoral approach. An aortic aneurysm was found in 10 patients (3.8%) and a "porcelain" aorta (heavily calcified ascending aorta) in 19 (7.3%). In conclusion, malignancy and other noncardiovascular abnormalities are often found in patients who undergo CT for evaluation for TAVI. Populations must be meticulously examined to ensure that important findings are not missed.
Ben-Dor
Itsik
I
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia, USA.
Waksman
Ron
R
Hanna
Nicholas N
NN
Raizon
Arnold
A
Satler
Lowell F
LF
Torguson
Rebecca
R
Weissman
Gaby
G
Okubagzi
Petros
P
Xue
Zhenyi
Z
Li
Yanlin
Y
Gonzalez
Manuel A
MA
Maluenda
Gabriel
G
Gaglia
Michael A
MA
Wakabayashi
Kohei
K
Delhaye
Cedric
C
Syed
Asmir I
AI
Collins
Sara D
SD
Suddath
William O
WO
Kent
Kenneth M
KM
Lindsay
Joseph
J
Pichard
Augusto D
AD
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome