Rofo 2014; 186 - VO320_4
DOI: 10.1055/s-0034-1372929

Structural changes of the aortic root detected by post transcatheter aortic valve replacement computed tomography angiography

G Pache 1, P Blanke 2, T Krauß 3, P Ruile 4, N Jander 4, HJ Büttner 4, FJ Neumann 4, M Langer 5
  • 1University Hospital Würzburg, Institute of Diagnostic and Interventional Radiology, Freiburg
  • 2University Hospital Würzburg, Institute of Diagnostic and Interventional Radiology, Würzburg
  • 3University Hospital Freiburg, Section of Cardiovascular Radiology, Department of Radiology, Freiburg
  • 4University Heart Center Freiburg – Bad Krozingen, Clinic for Cardiology and Angiology II, Bad Krozingen
  • 5University Hospital Freiburg, Department of Radiology, Freiburg

Zielsetzung:

To evaluate structural changes of the aortic root after transcatheter aortic valve replacement (TAVR) with computed tomography angiography (CTA).

Material und Methodik:

138 of 235 consecutive patients (58.7%, 68 women, mean age 82.8 ± 5.9 (range 65 – 94) years, mean Euro Score 17.8 ± 10.3, mean STS score 5.7 ± 4.6) who underwent TAVR with an Edwards Sapien XT valve (n = 21,86,29 (23,26,29 mm)) were examined with contrast-enhanced retrospective ECG-gated dual-source CTA within 6.4 ± 7.3 (range 0 – 82) days after intervention. Structural changes of the aortic root were compared with pre-TAVR CTA and echocardiographic findings.

Ergebnisse:

CTA revealed contained ruptures of the aortic root in 4 of 138 patients (2.9%). Three of these ruptures, all adjacent to the former left coronary cusp had been missed by periprocedural transesophageal echocardiography (TEE) as well as post-interventional transthoracic echocardiography (TTE), whereas one rupture extending to the right ventricular outflow tract was observed by CTA and TEE. Cusp thrombosis was depicted in one patient (0.7%) despite a normal mean pressure gradient of 9 mmHg on TTE and confirmed by TEE. In one patient periprocedual intramural hematoma of the ascending aortic, was confirmed by CTA. No coronary artery occlusion was observed.

Schlussfolgerungen:

CTA is a valuable tool in addition to echocardiography for depicting structural changes of the aortic root post TAVR. Due to prosthesis related narrowing of the acoustic window, especially adjacent to the former left coronary cusp, contained ruptures of the aortic root might represent an underestimated finding at echocardiography.

E-Mail: gregor.pache@uniklinik-freiburg.de