The use of MSCT for the evaluation of the aortic root before transcutaneous aortic valve implantation: the Rotterdam approach.
OBJECTIVE
Whereas transthoracic echocardiography is the modality of choice for the diagnosis of severe aortic stenosis and cine-fluoroscopy is used to guide the implantation of the TAVI prosthesis, we believe that multislice computer tomography (MSCT) is the modality of choice for evaluation of the aortic root with a view to selecting patients with suitable anatomy and to guide sizing. We aim to describe an anatomical approach for the step by step interrogation of a 3D MSCT dataset to obtain the measurements of the aortic root required for patient selection, sizing and selection of the optimal angulation of the C-arm during the implantation procedure.


RESULTS
The landmarks used to anatomically define the aortic annulus and structures of the aortic root may be used to define the same structures for measurement on a 3D MSCT dataset by setting up orthogonal cut-planes including one axial to the aortic annulus. This allows true axial diameter measurements and also enables us to define the valve plane.


CONCLUSIONS
Measurement on the axial images avoids incorrect diameter measurements that do not pass through the central axis.
Schultz
Carl
C
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Moelker
Adriaan
A
Tzikas
Apostolos
A
Piazza
Nicolo
N
de Feyter
Pim
P
van Geuns
Robert J
RJ
Serruys
Patrick W
PW
Krestin
Gabriel P
GP
de Jaegere
Peter
P
D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D014057:Tomography, X-Ray Computed / Q000379:methods*