Sandbox:lipid

TAVR Imaging Evaluation

TAVR CT

ECHO

Non-gated Angigram of Chest, Abdomen and Pelvic arteries for vascular access selection

ECG gated CT of annulus and Aortic root for valve sizing selection

Left ventricles and other findings

Confirm severe Aortic Stenosis

Transfemoral Approach

Annular sizing

Aortic Root sizing

Additional Procedural Planning

Subclavian Approach

Major/Minor Dimension

Coronary Ostia height

Fluoroscopy Angulation

LVEF and LV dimension

High gradient AS

Apical Approach

Area

Aortic Sinus to Commissure dimension

Bypass Grafts

Estimated Pulmonary pressure

Low gradient AS

Other Approaches

Circumferences

Sinotubular Junction

RV to Chest wall position

Other valvular abnormalities

Reduced EF

Carotid

Ascending Aorta dimension

Preserved EF

Direct Aortic

Aortic Calcification

Transvenous

TAVR Imaging Checklist
Region of Interest	Recommended Approach and Key Measures	Additional Comments
Preprocedure
Aortic valve morphology	TTE: Trileaflet, bicuspid or unicuspid Valve calcification Leaflet motion Annular size and shape	TEE if can be safely performed, particularly useful for subaortic membranes Cardiac MRI if echocardiography nondiagnostic ? ECG-gated thoracic CTA if MRI contraindicated
Aortic valve function	TTE: Maximum aortic velocity Mean aortic valve gradient Aortic valve area Stroke volume index Presence and severity of AR	Additional parameters Dimensionless index AVA by planimetry (echo, CT, MRI) Dobutamine stress echocardiography for LFLG AS-Reduced EF Aortic valve calcium score if LFLG AS diagnosis in question
LV Geometry and other cardiac findings	TTE: LVEF, regional wall motion Hypertrophy, diastolic dysfunction Pulmonary pressure estimate Mitral valve (MR, MS, MAC) Aortic sinus anatomy and size	? Myocardial ischemia and scar: CMR, PET, DSE, thallium ? CMR imaging for myocardial fibrosis and scar, identification of cardiomyopathies
Annular sizing	TAVR CTA- gated contrast enhanced CT thorax with multiphasic acquisition Typically reconstructed in systole 30-40% of the R-R window	Major/minor annulus dimension ?Major/minor average ?Annular area ?Circumference/perimeter
Aortic root measurements	Gated contrast-enhanced CT thorax with multiphasic acquisition. Typically reconstructed in diastole 60%–80%.	Coronary ostia heights ?Midsinus of Valsalva (sinus to commissure, sinus to sinus) ?Sinotubular junction ?Ascending aorta (40 cm above valve plane, widest dimension, at level of PA) ?Aortic root and ascending aorta calcification
Coronary disease and thoracic anatomy	Coronary angiography Nongated thoracic CTA	Coronary artery disease severity ?Bypass grafts: number/location ?RV to chest wall distance ?Aorta to chest wall relationship
Noncardiac imaging	Carotid ultrasound ?Cerebrovascular MRI	May be considered depending on clinical history

Vascular Access
Kidney Function Status	Recommended Approach	Key Parameters
Normal renal function (GFR >60) or ESRD not expected to recover	TAVR CTA	Aorta, great vessel, and abdominal aorta Dissection; atheroma; stenosis; calcification Iliac/subclavian/femoral luminal dimensions, calcification, and tortuosity
Borderline renal function	Contrast MRA ?Direct femoral angiography (low contrast)	Institutional dependent protocols ?Luminal dimensions and tortuosity of peripheral vasculature
Acute kidney injury or ESRD with expected recovery	Noncontrast CT of chest, abdomen, and pelvis ?Noncontrast MRA ?Can consider TEE if balancing risk/benefits	Degree of calcification and tortuosity of peripheral vasculature

TAVR Imaging Checklist
Imaging goals	Recommended Approach	Additional Details
Periprocedure
Interventional planning	TAVR CTA	Predict optimal fluoroscopy angles for valve deployment
Confirmation of annular sizing	Preprocedure MDCT	Consider contrast aortic root injection if needed ?3C TEE to confirm annular size
Valve placement	Fluoroscopy under general anesthesia	TEE (if using general anesthesia)
Paravalvular leak	Direct aortic root angiography	TEE (if using general anesthesia)
Procedural complications	TTE ?TEE (if using general anesthesia) ? Intracardiac echocardiography (alternative)
Long-term Postprocedure
Evaluate valve function	TTE	Key elements of echocardiography: Maximum aortic velocity Mean aortic valve gradient Aortic valve area Paravalvular and valvular AR
LV geometry and other cardiac findings	TTE: LVEF, regional wall motion Hypertrophy, diastolic fucntion Pulmonary pressure estimate Mitral valve (MR, MS, MAC)