1. CT Essentials for Optimizing Sizing and TAVR Planning
Gaby Weissman MD FACC
Medstar Heart & Vascular Institute
Georgetown University

2. No disclosures

3. Slice thickness <1.0mm
The Basics
The Basics
ECG Gating
Slice thickness <1.0mm
Multiphase imaging is generally not mandatory
May be preferable
The scanner
Contrast dose
Radiation dose
Image length
Aorta
Subclavian arteries
Iliac and femoral arteries
Does not need to be ECG gated

4. The Report Aortic Annulus Aortic valve Left ventricle Aortic root
Short vs long diameter
Area
Circumference
Calcification/ LVOT calcification
Aortic valve
Cuspidity (tri vs bi)
Calcification
Left ventricle
Masses/ thrombi
Aortic root
Sinus width
Sinus Height
Coronary heights
Thoracic aorta
Tortuosity
Intraluminal obstruction/ thrombi
Access vessels
Luminal diameter
Calcification

5. I. The Annulus

6. Aortic Annular Anatomy
Piazza N. Circ Cardiovasc Intervent

7. Techniques
Manual
Facilitated
Semi automated

8. The Annulus

9. The Annulus

10. The Annulus

11. The Annulus

12. Cardiac Phase
Blanke P. Radiology 2013.

13. Aortic Annular Calcifications
Barbanti M, Leipsic J. Circulation

14. Artifact - Motion

15. Artifact - Contrast Opacification

16. The Decision on the Valve and size are multifactorial
Annular Calcifications
The Decision on the Valve and size are multifactorial
All data available should be considered
Take into account
Image quality
Factors beyond the annular measures

17. The Decision on the Valve and size are multifactorial
Coronary Height
The Decision on the Valve and size are multifactorial
All data available should be considered
Take into account
Coronary height
Leaflets/ prosthetic valve leaflets

18. The Decision on the Valve and size are multifactorial
Sinotubular junction
The Decision on the Valve and size are multifactorial
All data available should be considered
Take into account
Size of the sinuses of Valsalva
Height, size and calcifications of the sinotubular junction

19. II. Fluoroscopic Orientation

20. Annular Angulation

21. III. The Coronaries

22. Coronary Heights

23. Coronary Obstruction
Ribeiro H JACC: Cardiovasc Intervent

24. Coronary Obstruction
Ribeiro H JACC: Cardiovasc Intervent

25. IV. The Valve

26. The valve
Bicuspid
Tricuspid

27. Bicuspid Valves

28. PVAR in TAVR in Bicuspid AS

29. Outcomes in TAVR in Bicuspid AS

30. Vi. Bioprosthetic Valves

31. Bioprosthetic Valve

36. V. The Aorta

38. The Aorta

39. VI. Access

40. Access

42. VII. Contrast

43. Contrast Dose
Kawaja MZ. Eurointervention 2012.

44. Dose Saving Techniques
50/50 contrast mixtures
Low kVp scans
Intra arterial contrast injections
Dual source scanners
eGFR based contrast medium dosing