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Utility of radiologic review for non-cardiac findings on MSCT in patients with severe aortic stenosis evaluated for TAVI

Philips CT Clinical Science Philips Healthcare

Ben-Dor I, Waksman R, Hanna NN, Raizon A, Satler LF, Torguson R, Weissman G, Okubagzi P, Xue Z, Li Y, Gonzalez MA, Maluenda G, Gaglia MA, Wakabayashi K, Delhaye C, Syed AI, Collins SD, Suddath WO, Kent KM, Lindsay J, and Pichard AD.

Division of Cardiology, Washington Hospital Center, Washington, District of Columbia.
*Originally published online April 2, 2010 in the American Journal of Cardiology.
Transcatheter aortic valve implantation (TAVI) without replacement requires precise knowledge of the anatomic dimensions and physical characteristics of the peripheral vasculature and aortic valve annulus at the insertion of the aortic valve leaflet and root at the level of the sinus of Valsalva. Multislice computed tomography (CT) allows detailed and precise assessment of the anatomic variables. Non-cardiovascular structures are also amenable to assessment by CT. Of the 394 patients screened for TAVI, 259 (65.7%) had non-contrast CT to evaluate chest anatomy and contrast CT to evaluate ilio-femoral anatomy.

Significant non-cardiac findings were defined as those requiring immediate evaluation or intervention or additional clinical or radiologic follow-up. Non-cardiovascular findings known before CT were not included. Of the 259 patients, 105 (40.5%) were men. The mean age was 82.3 ± 8.1 years.

New, significant non-cardiovascular findings were found in 89 (34.3%) and malignancy in 11 (4.2%) patients. Insignificant non-cardiovascular findings were identified in 222 patients (85.7%). Signs of fluid retention were noted on CT in 105 patients (40.5%), with pleural effusion in 100 (38.6%), ascites in 17 (6.5%), and pericardial effusion in 14 (5.4%). Important peripheral vascular disease was found in 98 patients (37.8%), resulting in exclusion of 49 (19.1%) from TAVI using the transfemoral approach. An aortic aneurysm was found in 10 patients (3.8%) and a "porcelain" aorta (heavily calcified ascending aorta) in 19 (7.3%).

In conclusion, malignancy and other non-cardiovascular abnormalities are often found in patients who undergo CT for evaluation for TAVI. Populations must be meticulously examined to ensure that important findings are not missed.
For more information about this publication, check out the PubMed listing for this article.

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Oct 25, 2010

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Brilliance 64-channel, iCT
abdomen, aneurysm, aorta, Aortic valve, Body, Cardiac, contrast, non-contrast, Pelvis, retrospective

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