RÉSUMÉ
Transcatheter aortic valve implantation (TAVI) has proven to be the standard of care for patients with prohibitive and high operative risk; today, it is considered a reasonable alternative to surgical aortic valve replacement in intermediate-risk patients. As indications for TAVI move toward patients at lower risk, safety aspects are becoming even more important. Furthermore, adequate patient selection is key for predictable procedural success with minimal complications, translating into an optimal clinical outcome. Decisions on valve type and size as well as on the access route are based on multimodality imaging including echocardiography, multislice computed tomography, and cardiac catheterization with peripheral angiography. This combination of multiple imaging modalities provides the best picture of a patient's anatomical and physiological suitability for the TAVI procedure. Yet, the reliability of preprocedural imaging is influenced by the quality of the images, which should be as high as possible, and both image acquisition and interpretation should be performed in a standardized manner. This article provides a concise overview of standardized multimodality imaging for the preprocedural planning and assessment of patients undergoing TAVI.
Sujet(s)
Angiographie , Sténose aortique/imagerie diagnostique , Sténose aortique/chirurgie , Échocardiographie , Tomodensitométrie multidétecteurs , Imagerie multimodale , Remplacement valvulaire aortique par cathéter/méthodes , Humains , Amélioration d'image , Planification des soins du patient , Pronostic , Appréciation des risquesSujet(s)
Maladie coronarienne/diagnostic , Maladie coronarienne/chirurgie , Embolie/diagnostic , Embolie/chirurgie , Imagerie multimodale/méthodes , Tomographie par cohérence optique/méthodes , Échographie interventionnelle/méthodes , Sujet âgé , Femelle , Humains , Chirurgie assistée par ordinateurRÉSUMÉ
Transcatheter aortic valve implantation (TAVI) is a viable treatment option for high- and prohibitive-risk patients with severe, calcified pure or predominant aortic valve stenosis, but not for pure aortic valve regurgitation. In fact, the use of TAVI for this indication is even considered unlikely due to the lack of calcium which appears essential for anchoring the stent-valve and prevents dislocation. We report a case of a patient with severe, symptomatic pure aortic regurgitation, and a history of two previous open-heart surgeries who was successfully treated by compassionate use implantation of an oversized Medtronic CoreValve prosthesis as an ultima ratio treatment option.