Präinterventionelle Klappenbildgebung in der CT: TAVR, TMVR und mehr

Zusammenfassung

Klappenerkrankungen zählen zu den häufigsten Herzerkrankungen, werden häufiger und können immer besser behandelt werden. Zwar benötigt nicht jede Klappenerkrankung zwingend eine radiologische Bildgebung, doch insbesondere für die Aorten- und Mitralklappe spielt die radiologische Beurteilung eine wichtige Rolle. In diesem Beitrag steht vor allem die CT vor Klappeneingriffen im Vordergrund.

Abstract

Valvular heart diseases (VHD) are among the most common cardiac diseases and are associated with increased mortality. While becoming more and more frequent in the clinical practice, the therapeutic options offer effective treatment in a broader variety of patients. Not every VHD necessarily requires radiological imaging, but especially for VHD of the aortic and mitral valves, radiographic evaluation plays an important role pre- and sometimes post-interventional. This article focuses primarily on computed tomography (CT) prior to valve interventions and provides insights into other radiological modalities and post-interventional valve imaging.

Kernaussagen

• Die Anzahl der Klappeninterventionen und der damit verbundenen präinterventionellen Bildgebungen nimmt stetig zu, auch aufgrund der zunehmenden Ausweitung der Indikation auf Patienten mit einem niedrigem Risikoprofil, besonders im Rahmen einer TAVR.

• Die Klappenintervention sollte in einem interdisziplinären Herzteam indiziert und geplant werden, hier sollte neben der Kardiologie und der Herzchirurgie auch die Radiologie vertreten sein.

• Die CT-Bildgebung zur Planung einer TAVR nimmt den größten Anteil der präinterventionellen Klappenbildgebungen ein und ist daher von besonderer Relevanz für den klinischen Alltag.

• Für die unterschiedlichen Herzklappenerkrankungen und Fragestellungen sind dedizierte CT-Protokolle notwendig, die – angepasst an die lokalen Gegebenheiten – in enger Zusammenarbeit mit den klinischen Kollegen erstellt werden sollten.

• Die adäquate metrische Analyse, ausgerichtet auf die klinische Fragestellung, sollte im Rahmen der Bildgebung vor Klappeninterventionen durchgeführt werden und Bestandteil des Befundes sein.

Schlüsselwörter

Herzklappenerkrankung - Computertomografie - Transkatheter-Aortenklappenersatz - Herzklappe

Key words

Valvular heart disease - computed tomography - transcatheter aortic valve replacement - cardiac valve

Publication History

Article published online:
08 June 2023

• Literatur

• 1 Iung B, Delgado V, Rosenhek R. et al. Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation 2019; 140: 1156-1169
• 2 Deutsche Herzstiftung e.V.. Deutscher Herzbericht 2021. September 2022. Im Internet (Stand: 21.03.2023): https://www.herzstiftung.de/system/files/2022-09/DHB21-Herzbericht-2021.pdf
• 3 Vahanian A, Beyersdorf F, Praz F. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2022; 43: 561-632
• 4 Bing R, Cavalcante JL, Everett RJ. et al. Imaging and Impact of Myocardial Fibrosis in Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12: 283-296
• 5 Cueff C, Serfaty JM, Cimadevilla C. et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 2011; 97: 721-726
• 6 Coylewright M, Blumenthal RS, Post W. Placing COURAGE in context: review of the recent literature on managing stable coronary artery disease. Mayo Clin Proc 2008; 83: 799-805
• 7 McDonald JS, McDonald RJ, Carter RE. et al. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology 2014; 271: 65-73
• 8 Otto CM, Prendergast B. Aortic-valve stenosis – from patients at risk to severe valve obstruction. N Engl J Med 2014; 371: 744-756
• 9 Arnold SV, Reynolds MR, Lei Y. et al. Predictors of poor outcomes after transcatheter aortic valve replacement: results from the PARTNER (Placement of Aortic Transcatheter Valve) trial. Circulation 2014; 129: 2682-2690
• 10 Pibarot P, Magne J, Leipsic J. et al. Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging 2019; 12: 149-162
• 11 Baumgartner H, Falk V, Bax JJ. et al. 2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Rev Esp Cardiol (Engl Ed) 2018; 71: 110
• 12 Agatston AS, Janowitz WR, Hildner FJ. et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832
• 13 Willson AB, Webb JG, Freeman M. et al. Computed tomography-based sizing recommendations for transcatheter aortic valve replacement with balloon-expandable valves: Comparison with transesophageal echocardiography and rationale for implementation in a prospective trial. J Cardiovasc Comput Tomogr 2012; 6: 406-414
• 14 Gulati M, Levy PD, Mukherjee D. et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144: e368-e454
• 15 Abbara S, Blanke P, Maroules CD. et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2016; 10: 435-449
• 16 Bittner DO, Arnold M, Klinghammer L. et al. Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation. Eur Radiol 2016; 26: 4497-4504
• 17 Schmidtke C, Sievers HH, Frydrychowicz A. et al. First clinical results with the new sinus prosthesis used for valve-sparing aortic root replacement. Eur J Cardiothorac Surg 2013; 43: 585-590
• 18 Wienemann H, Langenbach MC, Mauri V. et al. Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis. J Cardiovasc Dev Dis 2022; 9: 116
• 19 Gohmann RF, Pawelka K, Seitz P. et al. Combined cCTA and TAVR Planning for Ruling Out Significant CAD: Added Value of ML-Based CT-FFR. JACC Cardiovasc Imaging 2022; 15: 476-486
• 20 Ribeiro HB, Webb JG, Makkar RR. et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 2013; 62: 1552-1562
• 21 Feuchtner GM, Alkadhi H, Karlo C. et al. Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography1. Radiology 2010; 254: 374-383
• 22 Braunberger E, Deloche A, Berrebi A. et al. Very long-term results (more than 20 years) of valve repair with carpentierʼs techniques in nonrheumatic mitral valve insufficiency. Circulation 2001; 104: 8-11
• 23 Alfieri O, De Bonis M. The role of the edge-to-edge repair in the surgical treatment of mitral regurgitation. J Card Surg 2010; 25: 536-541
• 24 Gheorghe LL, Mobasseri S, Agricola E. et al. Imaging for Native Mitral Valve Surgical and Transcatheter Interventions. JACC Cardiovasc Imaging 2021; 14: 112-127
• 25 Blanke P, Weir-McCall JR, Achenbach S. et al. Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR): An Expert Consensus Document of the Society of Cardiovascular Computed Tomography. JACC Cardiovasc Imaging 2019; 12: 1-24
• 26 Faletra FF, Leo LA, Paiocchi VL. et al. Anatomy of mitral annulus insights from non-invasive imaging techniques. Eur Heart J Cardiovasc Imaging 2019; 20: 843-857
• 27 Sud K, Agarwal S, Parashar A. et al. Degenerative Mitral Stenosis: Unmet Need for Percutaneous Interventions. Circulation 2016; 133: 1594-1604
• 28 Bapat V, Pirone F, Kapetanakis S. et al. Factors influencing left ventricular outflow tract obstruction following a mitral valve-in-valve or valve-in-ring procedure, part 1. Catheter Cardiovasc Interv 2015; 86: 747-760
• 29 Topilsky Y, Maltais S, Medina Inojosa J. et al. Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting. JACC Cardiovasc Imaging 2019; 12: 433-442
• 30 Grothues F, Moon JC, Bellenger NG. et al. Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J 2004; 147: 218-223
• 31 Latib A, Agricola E, Pozzoli A. et al. First-in-Man Implantation of a Tricuspid Annular Remodeling Device for Functional Tricuspid Regurgitation. JACC Cardiovasc Interv 2015; 8: e211-214
• 32 Saremi F, Gera A, Ho SY. et al. CT and MR imaging of the pulmonary valve. RadioGraphics 2014; 34: 51-71