Work up prior to TAVI

Q: 82 years old female is admitted to ICU with shortness of breath(SOB). Subsequent workup led to the diagnosis of Aortic Stenosis(AS). Plan is made to perform Transcatheter Aortic Valve Implantation (TAVI). The surgical team requests the ICU team to perform a preprocedural workup. Which of the following is considered a standard test before TAVI? (select one)

A) Multidetector computed tomography (MDCT) angiography

B) Cardiac magnetic resonance (CMR) 

Answer: A

In morbidly elder patients with critical or severe AS, TAVI is fastly becoming a procedure of choice. A few essential workups include echocardiography, mostly transthoracic (transesophageal per clinician's discretion), coronary angiogram, which may include aortography and peripheral angiography, and Multidetector computed tomography (MDCT).

MDCT angiography is now universally considered a standard as it provides essential information regarding aortic annulus and sinus dimensions, descending aorta, and iliofemoral vascular system. 

MDCT can be challenging in patients with renal dysfunction, dye allergy, arrhythmias, and pulmonary disease. In such cases, cardiac magnetic resonance (CMR) is a noninvasive modality and provides detailed visualization of cardiac structures and quantitative flow measurements.

#surgical-critical-care

References: 

1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.

2. Binder RK, Webb JG, Willson AB, et al. The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol 2013; 62:431.

3. Lopez-Mattei JC, Shah DJ. When to consider cardiovascular magnetic resonance in patients undergoing transcatheter aortic valve replacement? Curr Opin Cardiol 2013; 28:505.