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Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves. [ABSTRACT FROM AUTHOR]

Background Motion correction (MC) algorithms have been shown to improve image quality, interpretability and diagnostic accuracy in coronary CT angiography. We sought to determine whether MC extended to the whole heart would demonstrate improved image quality and reproducibility of aortic annular measurements in pre-TAVR CT. Materials and methods Twenty-two consecutive contrast enhanced CT data sets acquired for pre TAVR evaluation using retrospective ECG synchronization during a single heart beat were retrospectively identified. Image data sets were obtained from raw data acquired at 35% and 75% of the R-R interval using both standard (STD) and motion corrected (MC) reconstruction algorithms. Four data sets (2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers for aortic annular area, short and long axis, perimeter and average diameter. Image quality was graded using a 5 point Likert score (1 and 2 non diagnostic, 5 excellent). Statistical analysis was performed using Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75% MC. Results Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%, there was a significant improvement in image quality for MC (Likert score 3.3 ± 0.9 STD vs. 3.9 ± 0.7 MC, p < 0.007). While B-A analysis demonstrated narrower interobserver agreement for aortic annular area (bias 0.03 vs 0.02 cm 2 , range −0.32 to 0.39 cm 2 vs −0.50 to 0.55 cm 2 ), and perimeter (bias 0.3 vs 0.3 mm, range −3.1 to 3.8 mm vs −4.6 to 5.3 mm), this was not statistically significant by concordance correlation coefficient. At 75%, there was no significant difference in image quality (Likert score 3.3 ± 0.9 vs. 3.5 ± 0.76, p = 0.454) or annular measurement agreement intervals. Conclusion Motion correction algorithms may yield significant improvements of image quality in systolic CT data sets of the heart. Further validation studies are required to determine the effect on annular measurements and translation into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction We sought to validate whether low dose CACS CT with hybrid IR (HIR) could replace standard dose filtered back projection (FBP). Method We enrolled 100 patients to undergo low dose CACS CT with HIR, in addition to routine full dose FBP. Results No significant difference between full and low dose CT in Agatston score 138.2 ± 360.6 vs. 137.3 ± 356.4 (p = 0.272) or calcium mass score 19 ± 48.3 vs. 18.7 ± 49 (p = 0.8), respectively. Bland–Altman analysis showed no systematic bias. Calcium volume difference was statistically significant 57.2 ± 134 vs. 55.1 ± 130.2 (p = 0.001). Conclusion Low dose CT for calcium scoring with HIR enables stable CACS Agatston score and calcium mass quantification as compared to full dose FBP. [ABSTRACT FROM AUTHOR]