Interpretation of Chinese expert consensus on CT examination techniques and standardized evaluation for transcatheter aortic valve replacement_West China Medical Journal

Authors：

YAO Jing ,  SONG Guangyuan

Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

SONG Guangyuan, Email: songgy_anzhen@vip.163.com

Keywords：

Transcatheter aortic valve replacement; CT examination; standardized evaluation; expert consensus; aortic stenosis

DOI：

10.7507/1002-0179.202408175

Video：

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This article interprets the core content of Chinese expert consensus on the CT examination for transcatheter aortic valve replacement and Chinese expert consensus on standardized evaluation of CT for transcatheter aortic valve replacement, and elaborates on the technical points of preoperative and postoperative CT examination for transcatheter aortic valve replacement (TAVR), including patient preparation, data acquisition, image reconstruction, and contrast agent use strategies. The article also provides an in-depth interpretation of the crucial elements in standardized CT evaluation for TAVR, covering assessments of aortic root anatomy, cardiac morphology, coronary arteries, and surgical access routes. The article emphasizes the significance of the above consensuses in standardizing TAVR-related CT examinations, improving diagnosis and treatment quality, and promoting the development of cardiovascular intervention therapy in China.

1.	Eltchaninoff H, Zajarias A, Tron C, et al. Transcatheter aortic valve implantation: technical aspects, results and indications. Arch Cardiovasc Dis, 2008, 101(2): 126-132.
2.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
3.	Bonow RO, Brown AS, Gillam LD, et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2017, 70(20): 2566-2598.
4.	中国医师协会放射医师分会心血管学组, 国家心血管病专业质控中心心血管影像质控专家工作组, 中国研究型医院学会心血管影像专业委员会. 经导管主动脉瓣置换术 CT 检查技术中国专家共识. 中华放射学杂志, 2024, 58(4): 365-374.
5.	中国医师协会放射医师分会心血管学组, 国家心血管病专业质控中心心血管影像质控专家工作组, 中国研究型医院学会心血管影像专业委员会. 经导管主动脉瓣置换术 CT 规范化评估中国专家共识. 中华放射学杂志, 2024, 58(6): 576-586.
6.	中华医学会放射学分会对比剂安全使用工作组. 碘对比剂使用指南(第 2 版). 中华医学杂志, 2014, 94(43): 3363-3369.
7.	北京市医学影像质量控制与改进中心专家组. 北京市“对比剂使用知情同意书”推荐模板. 中国医学影像技术, 2016, 32(7): 1143-1145.
8.	Achenbach S, Delgado V, Hausleiter J, et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr, 2012, 6(6): 366-380.
9.	Felmly LM, De Cecco CN, Schoepf UJ, et al. Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning. Eur Radiol, 2017, 27(5): 1944-1953.
10.	Mangold S, De Cecco CN, Schoepf UJ, et al. CT angiography for planning transcatheter aortic valve replacement using automated tube voltage selection: image quality and radiation exposure. Eur J Radiol, 2017, 86: 276-283.
11.	Mata-Mbemba D, Labani A, El Ghannudi S, et al. 320-row CT transcatheter aortic valve replacement planning with a single reduced contrast media bolus injection. PLoS One, 2018, 13(9): e0204145.
12.	Kok M, Turek J, Mihl C, et al. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol, 2016, 26(8): 2426-2435.
13.	Faggiano P, Frattini S, Zilioli V, et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. potential implications for the decision-making process. Int J Cardiol, 2012, 159(2): 94-99.
14.	van Mourik MS, van Kesteren F, Planken RN, et al. Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography. Neth Heart J, 2018, 26(9): 425-432.
15.	Chow BJW, Coyle D, Hossain A, et al. Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C). Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1083-1090.
16.	Expert Panel on Cardiac Imaging, White RD, Kirsch J, et al. ACR appropriateness criteria^® suspected new-onset and known nonacute heart failure. J Am Coll Radiol, 2018, 15(11S): S418-S431.
17.	Meinel FG, Bayer RR 2nd, Zwerner PL, et al. Coronary computed tomographic angiography in clinical practice: state of the art. Radiol Clin North Am, 2015, 53(2): 287-296.
18.	Abbara S, Blanke P, Maroules CD, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr, 2016, 10(6): 435-449.
19.	Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the Society of Cardiovascular Computed Tomography. JACC Cardiovasc Imaging, 2019, 12(1): 1-24.
20.	Marwan M, Mekkhala N, Göller M, et al. Leaflet thrombosis following transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr, 2018, 12(1): 8-13.
21.	Elattar MA, Vink LW, van Mourik MS, et al. Dynamics of the aortic annulus in 4D CT angiography for transcatheter aortic valve implantation patients. PLoS One, 2017, 12(9): e0184133.
22.	Dahiya A, Coucher J, Pratap J, et al. Multiphase TAVR CT identifies unexpected sticky situation (mechanical mitral valve leaflet dysfunction and bicuspid aortic valve). J Cardiovasc Comput Tomogr, 2021, 15(3): e22-e24.
23.	Zgheib A, Campens L, Abualsaud A, et al. Aortic annulus S-curve: implications for transcatheter aortic valve replacement and related procedures, part 1. JACC Cardiovasc Interv, 2022, 15(23): 2353-2373.
24.	Ribeiro HB, Nombela-Franco L, Urena M, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv, 2013, 6(5): 452-461.
25.	Yousef S, Brown JA, Kliner D, et al. Transfemoral versus subclavian access for transcatheter aortic valve replacement. Innovations (Phila), 2022, 17(2): 95-101.
26.	Raptis DA, Beal MA, Kraft DC, et al. Transcatheter aortic valve replacement: alternative access beyond the femoral arterial approach. Radiographics, 2019, 39(1): 30-43.
27.	Hein M, Breitbart P, Minners J, et al. Performance of computed tomography angiography (CTA) for the diagnosis of hypo-attenuated leaflet thickening (HALT). J Clin Med, 2022, 11(7): 1817.

1. Eltchaninoff H, Zajarias A, Tron C, et al. Transcatheter aortic valve implantation: technical aspects, results and indications. Arch Cardiovasc Dis, 2008, 101(2): 126-132.
2. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
3. Bonow RO, Brown AS, Gillam LD, et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2017, 70(20): 2566-2598.
4. 中国医师协会放射医师分会心血管学组, 国家心血管病专业质控中心心血管影像质控专家工作组, 中国研究型医院学会心血管影像专业委员会. 经导管主动脉瓣置换术 CT 检查技术中国专家共识. 中华放射学杂志, 2024, 58(4): 365-374.
5. 中国医师协会放射医师分会心血管学组, 国家心血管病专业质控中心心血管影像质控专家工作组, 中国研究型医院学会心血管影像专业委员会. 经导管主动脉瓣置换术 CT 规范化评估中国专家共识. 中华放射学杂志, 2024, 58(6): 576-586.
6. 中华医学会放射学分会对比剂安全使用工作组. 碘对比剂使用指南(第 2 版). 中华医学杂志, 2014, 94(43): 3363-3369.
7. 北京市医学影像质量控制与改进中心专家组. 北京市“对比剂使用知情同意书”推荐模板. 中国医学影像技术, 2016, 32(7): 1143-1145.
8. Achenbach S, Delgado V, Hausleiter J, et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr, 2012, 6(6): 366-380.
9. Felmly LM, De Cecco CN, Schoepf UJ, et al. Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning. Eur Radiol, 2017, 27(5): 1944-1953.
10. Mangold S, De Cecco CN, Schoepf UJ, et al. CT angiography for planning transcatheter aortic valve replacement using automated tube voltage selection: image quality and radiation exposure. Eur J Radiol, 2017, 86: 276-283.
11. Mata-Mbemba D, Labani A, El Ghannudi S, et al. 320-row CT transcatheter aortic valve replacement planning with a single reduced contrast media bolus injection. PLoS One, 2018, 13(9): e0204145.
12. Kok M, Turek J, Mihl C, et al. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol, 2016, 26(8): 2426-2435.
13. Faggiano P, Frattini S, Zilioli V, et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. potential implications for the decision-making process. Int J Cardiol, 2012, 159(2): 94-99.
14. van Mourik MS, van Kesteren F, Planken RN, et al. Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography. Neth Heart J, 2018, 26(9): 425-432.
15. Chow BJW, Coyle D, Hossain A, et al. Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C). Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1083-1090.
16. Expert Panel on Cardiac Imaging, White RD, Kirsch J, et al. ACR appropriateness criteria^® suspected new-onset and known nonacute heart failure. J Am Coll Radiol, 2018, 15(11S): S418-S431.
17. Meinel FG, Bayer RR 2nd, Zwerner PL, et al. Coronary computed tomographic angiography in clinical practice: state of the art. Radiol Clin North Am, 2015, 53(2): 287-296.
18. Abbara S, Blanke P, Maroules CD, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr, 2016, 10(6): 435-449.
19. Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the Society of Cardiovascular Computed Tomography. JACC Cardiovasc Imaging, 2019, 12(1): 1-24.
20. Marwan M, Mekkhala N, Göller M, et al. Leaflet thrombosis following transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr, 2018, 12(1): 8-13.
21. Elattar MA, Vink LW, van Mourik MS, et al. Dynamics of the aortic annulus in 4D CT angiography for transcatheter aortic valve implantation patients. PLoS One, 2017, 12(9): e0184133.
22. Dahiya A, Coucher J, Pratap J, et al. Multiphase TAVR CT identifies unexpected sticky situation (mechanical mitral valve leaflet dysfunction and bicuspid aortic valve). J Cardiovasc Comput Tomogr, 2021, 15(3): e22-e24.
23. Zgheib A, Campens L, Abualsaud A, et al. Aortic annulus S-curve: implications for transcatheter aortic valve replacement and related procedures, part 1. JACC Cardiovasc Interv, 2022, 15(23): 2353-2373.
24. Ribeiro HB, Nombela-Franco L, Urena M, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv, 2013, 6(5): 452-461.
25. Yousef S, Brown JA, Kliner D, et al. Transfemoral versus subclavian access for transcatheter aortic valve replacement. Innovations (Phila), 2022, 17(2): 95-101.
26. Raptis DA, Beal MA, Kraft DC, et al. Transcatheter aortic valve replacement: alternative access beyond the femoral arterial approach. Radiographics, 2019, 39(1): 30-43.
27. Hein M, Breitbart P, Minners J, et al. Performance of computed tomography angiography (CTA) for the diagnosis of hypo-attenuated leaflet thickening (HALT). J Clin Med, 2022, 11(7): 1817.

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