Post-procedural structural heart CT imaging: TAVR, TMVR, and other interventions

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Transcatheter valve replacement is rapidly expanding to all four heart valves.
• Transcatheter aortic valve replacement (TAVR) now surpasses surgical replacement.
• Transcatheter mitral (TMVR), tricuspid (TTVR), and pulmonic (TPVR) valve replacements are under active development or used for specific conditions.

Purpose of the Study:

• To review normal and abnormal post-procedural CT findings for transcatheter valve replacement.
• To highlight common and valve-specific complications encountered in post-procedural imaging.
• To equip radiologists with knowledge for unexpected cases.

Main Methods:

• Review of post-procedural CT imaging in patients undergoing transcatheter valve replacement.
• Analysis of normal device appearances and potential complications.
• Categorization of complications by valve type and access.

Main Results:

• Common complications include device migration, paravalvular leak, and leaflet thrombosis.
• Valve-specific complications include coronary artery occlusion (TAVR), compression (TPVR), and LVOT obstruction (TMVR).
• Access-related complications are also a significant concern.

Conclusions:

• Radiologists require detailed knowledge of transcatheter valve replacement imaging to accurately interpret CT scans.
• Understanding potential post-procedural appearances and complications is crucial for patient management.
• This review provides a comprehensive guide to navigating these complex cases.