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Aortic Annular Geometry and Sizing: CT

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Multimodality Imaging for Transcatheter Aortic Valve Replacement

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Abstract

Calcified aortic stenosis is the most common valvular heart disease in the elderly and is associated with significant morbidity and mortality after the onset of symptoms. Surgical aortic valve replacement (SAVR) improves symptoms and survival, however many patients with severe aortic stenosis do not undergo SAVR due to multiple coexisting comorbidities. Transcatheter aortic valve replacement (TAVR) has recently emerged as a novel method to treat these selected high-risk patients with aortic stenosis. Moderate or severe paravalvular aortic regurgitation (PAR) is significantly higher for high-risk TAVR patients compared to surgical patients and is an independent predictor of short-, mid-, and long-term mortality. PAR following TAVR has been shown to be related to prosthesis-annulus incongruence, highlighting the importance of appropriate annular measurements, especially given that current TAVR devices are limited to specific annular sizes. Multiple imaging modalities have been used to measure aortic annulus. This chapter focuses on anatomy of aortic annulus, comparison of different imaging modalities, clinical significance, and our recommendations for measuring aortic annulus using multi-detector computed tomography (MDCT).

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Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, David Geffen UCLA School of Medicine, Los Angeles, CA, USA

    Reza Arsanjani MD

  2. Division of Cardiology, Department of Radiology, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada

    Jonathon Leipsic MD, FRCPC, FSCCT

  3. Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute,David Geffen UCLA School of Medicine, Los Angeles, CA, USA

    Daniel S. Berman MD

  4. Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY, USA

    James K. Min MD, FACC, FSCCT

Authors
  1. Reza Arsanjani MD
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  2. Jonathon Leipsic MD, FRCPC, FSCCT
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  3. Daniel S. Berman MD
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  4. James K. Min MD, FACC, FSCCT
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Correspondence to James K. Min MD, FACC, FSCCT .

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Editors and Affiliations

  1. NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA

    James K. Min

  2. Departments of Imaging and Medicine, David Geffen UCLA School of Medicine, Cedars-Sinai Medical Center Cedars-Sinai Heart Institute, Los Angeles, California, USA

    Daniel S. Berman

  3. Department of Cardiology, St. Paul’s Hospital, University of British Columbia Department of Radiology, Vancouver, British Columbia, Canada

    Jonathon Leipsic

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Arsanjani, R., Leipsic, J., Berman, D.S., Min, J.K. (2014). Aortic Annular Geometry and Sizing: CT. In: Min, J., Berman, D., Leipsic, J. (eds) Multimodality Imaging for Transcatheter Aortic Valve Replacement. Springer, London. https://doi.org/10.1007/978-1-4471-2798-7_25

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  • DOI: https://doi.org/10.1007/978-1-4471-2798-7_25

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