The Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

Multimodality imaging is integral for diagnosis, procedural guidance, and follow-up of patients undergoing transcatheter aortic valve replacement (TAVR). In this review, we provide an overview of the role of each imaging modality and highlight technical considerations and pitfalls. We also address current controversies and new developments in the field.

Echocardiography remains the primary imaging modality for diagnosis of aortic stenosis and intraprocedural guidance for TAVR, but computed tomography (CT) imaging has supplanted echocardiography for annular sizing and access site evaluation. Magnetic resonance imaging (MRI) shows promise in targeted patient populations. Refined parameters and guidelines for valve sizing and paravalvular regurgitation have sought to standardize these complex assessments. Multimodality imaging remains critical to the success of TAVR, but its role has evolved over time. Understanding the applications, strengths, and limitations of each imaging modality is a crucial skill for the modern structural imager.