The Role of Selective Multidetector Computed Tomography After a Transcatheter Aortic Valve Implant

Transcatheter aortic valve implants are increasingly performed in younger and lower-risk patients, shifting attention towards long-term prosthetic valve durability. Although transthoracic echocardiography remains the cornerstone of follow-up, it primarily reflects global haemodynamics and may not detect early structural or geometric abnormalities after the valve is implanted. Hypoattenuated leaflet thickening and reduced leaflet motion, collectively referred to as subclinical leaflet thrombosis, represent dynamic phenomena that may precede overt valve dysfunction. Growing evidence suggests that prosthesis geometry, including underexpansion, ellipticity, commissural misalignment, canting, and implant depth, may alter neo-sinus flow and promote thrombotic substrate formation. Multidetector computed tomography enables integrated assessment of leaflet morphology, perivalvular thrombus, and prosthetic geometry, providing insights into the mechanical determinants of thrombosis. In this state-of-the-art review, we examine the role of multimodality imaging in identifying thrombogenic valve phenotypes and propose a pragmatic imaging framework integrating echocardiography with selective multidetector computed tomography to support the surveillance and management of individualized post-transcatheter aortic valve implants.