Skip to main content
SpringerLink
Log in

Angiography and Rotational Angiography for TAVR

  • Chapter
  • First Online:
Multimodality Imaging for Transcatheter Aortic Valve Replacement

  • 1021 Accesses

Abstract

Angiography (or fluoroscopy) is essential for guidance during transcatheter aortic valve replacement (TAVR); however its utility to assess aortic annulus dimension is not well established. Only a few small-scale studies have compared angiographic measurements with other imaging modalities. In general, they have observed moderate correlation with multidetector row CT (MDCT) and transesophageal echocardiography (TEE). However intra- and interobserver reproducibility was only moderate with angiography and inferior to other modalities. Newer technology—such as the Paieon’s C-THV system—has been developed to help identify adequate perpendicular views to the annulus to facilitate accurate deployment and has been shown to be effective. Rotational angiography has been recently applied to TAVR, and preliminary data suggest a possible role for evaluation of aortic annulus dimensions as well as enhanced placement accuracy but more robust studies are needed. Rotational angiography has, however, been demonstrated to predict optimal projection angles reliably, with less radiation than MDCT and with limited use of iodinated contrast. These factors suggest the use of angiography and rotational angiography to be useful for assessment of aortic dimension and determination of optimal projection angles.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

LAO:

Left anterior oblique

LVOT:

Left ventricular outflow tract

MDCT:

Multidetector computed tomography

MRI:

Magnetic resonance imaging

RAO:

Right anterior oblique

STJ:

Sinotubular junction

TAVR:

Transcatheter aortic valve replacement

TEE:

Transesophageal echocardiogram

THV:

Transcatheter heart valve

TTE:

Transthoracic echocardiogram

2D:

2-dimensional

3D:

3-dimensional

3DA:

3-dimensional angiography

References

  1. Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, et al. Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J Am Coll Cardiol. 2012;59(14):1275–86. Epub 2012/03/01.

    Article  PubMed  Google Scholar 

  2. Willson AB, Webb JG, Labounty TM, Achenbach S, Moss R, Wheeler M, et al. 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. J Am Coll Cardiol. 2012;59(14):1287–94. Epub 2012/03/01.

    Article  PubMed  Google Scholar 

  3. Jabbour A, Ismail TF, Moat N, Gulati A, Roussin I, Alpendurada F, et al. Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. J Am Coll Cardiol. 2011;58(21):2165–73. Epub 2011/11/15.

    Article  PubMed  Google Scholar 

  4. Unbehaun A, Pasic M, Dreysse S, Drews T, Kukucka M, Mladenow A, et al. Transapical aortic valve implantation: incidence and predictors of paravalvular leakage and transvalvular regurgitation in a series of 358 patients. J Am Coll Cardiol. 2012;59(3):211–21. Epub 2012/01/14.

    Article  PubMed  Google Scholar 

  5. Altiok E, Koos R, Schröder J, Brehmer K, Hamada S, Becker M, et al. Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation. Heart. 2011;97(19):1578–84.

    Article  PubMed  Google Scholar 

  6. Kurra V, Kapadia SR, Tuzcu EM, Halliburton SS, Svensson L, Roselli EE, et al. Pre-procedural imaging of aortic root orientation and dimensions: comparison between X-ray angiographic planar imaging and 3-dimensional multidetector row computed tomography. JACC Cardiovasc Interv. 2010;3(1):105–13.

    Article  PubMed  Google Scholar 

  7. Tzikas A, Schultz CJ, Piazza N, Moelker A, Van Mieghem NM, Nuis R-J, et al. Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2011;77(6):868–75.

    Article  PubMed  Google Scholar 

  8. Paelinck BP, Van Herck PL, Rodrigus I, Claeys MJ, Laborde J-C, Parizel PM, et al. Comparison of magnetic resonance imaging of aortic valve stenosis and aortic root to multimodality imaging for selection of transcatheter aortic valve implantation candidates. Am J Cardiol. 2011;108(1):92–8.

    Article  PubMed  Google Scholar 

  9. Bagur R, Rodés-Cabau J, Doyle D, De Larochellière R, Villeneuve J, Lemieux J, et al. Usefulness of TEE as the primary imaging technique to guide transcatheter transapical aortic valve implantation. JACC Cardiovasc Imaging. 2011;4(2):115–24.

    Article  PubMed  Google Scholar 

  10. Tzikas A, Schultz C, Van Mieghem NM, de Jaegere PPT, Serruys PW. Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography: validation of a Prototype Software. Catheter Cardiovasc Interv. 2010;76(4):602–7.

    Article  PubMed  Google Scholar 

  11. Daneault B, Koss E, Hahn RT, Kodali S, Williams MR, Généreux P, et al. Efficacy and safety of postdilatation to reduce paravalvular regurgitation during balloon-expandable transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2013;6(1):85–91.

    Google Scholar 

  12. Lauritsch G, Boese J, Wigstrom L, Kemeth H, Fahrig R. Towards cardiac C-arm computed tomography. IEEE Trans Med Imaging. 2006;25(7):922–34. Epub 2006/07/11.

    Article  PubMed  Google Scholar 

  13. Bai M, Liu B, Mu H, Liu X, Jiang Y. The comparison of radiation dose between C-arm flat-detector CT (DynaCT) and multi-slice CT (MSCT): a phantom study. Eur J Radiol. 2012;81:3577–80.

    Article  PubMed  Google Scholar 

  14. Binder RK, Leipsic J, Wood D, Moore T, Toggweiler S, Willson A, et al. Prediction of optimal deployment projection for transcatheter aortic valve replacement: angiographic 3-dimensional reconstruction of the aortic root versus multidetector computed tomography. Circulation: Cardiovascular Interventions; 2012.

    Google Scholar 

  15. Meyhöfer J, Ahrens J, Neuss M, Hölschermann F, Schau T, Butter C. Rotational angiography for preinterventional imaging in transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2012;79(5):756–65.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada

    Benoit Daneault MD, FRCPC

  2. Department of Medicine, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA

    Jeffrey W. Moses MD

Authors
  1. Benoit Daneault MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey W. Moses MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benoit Daneault MD, FRCPC .

Editor information

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

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Daneault, B., Moses, J.W. (2014). Angiography and Rotational Angiography for TAVR. 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_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2798-7_30

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2797-0

  • Online ISBN: 978-1-4471-2798-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation