CTA Coronary Arteries With IV Contrast There is no relevant literature to support the use of CTA coronary arteries with IV contrast as the initial imaging modality for the assessment of aortic root. Although CTA coronary arteries with IV contrast can evaluate coronary anatomy and stenosis, which can be helpful in the management of patients undergoing TAVR, it does not impact selection of device type and/or size. A multiphase coronary CTA can also be used for evaluation and sizing of the annulus and aortic root. MRA Chest With IV Contrast Although a majority of the evidence focuses on noncontrast MR angiography (MRA) techniques for root assessment, contrast-enhanced MRA may provide faster acquisition [45]. MRA Chest Without and With IV Contrast In a prospective study of 69 patients, Ruile et al [46] observed good reproducibility of aortic annulus dimensions and calcifications in comparison with cardiac CTA, even in the presence of arrhythmias in the all-comers pre-TAVR population and useful in patients at an increased risk for contrast-induced nephropathy with an agreement for hypothetical prosthesis sizing in 63 of 67 (94%) patients for systolic CTA and modeled systolic MRA. Also, excellent correlation was reported for the distance to the right or left coronary ostium between diastolic CTA and diastolic MRA. The role of MRA is; however, limited when there is a high-susceptibility artifact, magnetic field incompatible devices, and severe arrhythmia. Finally, the MRA examination is a technically more complex examination, with longer study time and a higher required degree of patient cooperation, which can be problematic for patients with a poor clinical condition [47]. MRA Coronary Arteries Without and With IV Contrast There is no relevant literature to support the use of MRA coronary arteries without and with IV contrast as the initial imaging modality for the assessment of aortic root.
Preprocedural Planning for Transcatheter Aortic Valve Replacement. CTA Coronary Arteries With IV Contrast There is no relevant literature to support the use of CTA coronary arteries with IV contrast as the initial imaging modality for the assessment of aortic root. Although CTA coronary arteries with IV contrast can evaluate coronary anatomy and stenosis, which can be helpful in the management of patients undergoing TAVR, it does not impact selection of device type and/or size. A multiphase coronary CTA can also be used for evaluation and sizing of the annulus and aortic root. MRA Chest With IV Contrast Although a majority of the evidence focuses on noncontrast MR angiography (MRA) techniques for root assessment, contrast-enhanced MRA may provide faster acquisition [45]. MRA Chest Without and With IV Contrast In a prospective study of 69 patients, Ruile et al [46] observed good reproducibility of aortic annulus dimensions and calcifications in comparison with cardiac CTA, even in the presence of arrhythmias in the all-comers pre-TAVR population and useful in patients at an increased risk for contrast-induced nephropathy with an agreement for hypothetical prosthesis sizing in 63 of 67 (94%) patients for systolic CTA and modeled systolic MRA. Also, excellent correlation was reported for the distance to the right or left coronary ostium between diastolic CTA and diastolic MRA. The role of MRA is; however, limited when there is a high-susceptibility artifact, magnetic field incompatible devices, and severe arrhythmia. Finally, the MRA examination is a technically more complex examination, with longer study time and a higher required degree of patient cooperation, which can be problematic for patients with a poor clinical condition [47]. MRA Coronary Arteries Without and With IV Contrast There is no relevant literature to support the use of MRA coronary arteries without and with IV contrast as the initial imaging modality for the assessment of aortic root.