Fourzali-Sabbag A, Criales-Vera S, Castillo-Castrillón F, Díaz-Zamudio M

Language: Spanish
References: 22
Page: 51-61
PDF size: 567.45 Kb.

ABSTRACT

A large number of symptomatic patients, with severe aortic stenosis, are excluded from surgery due to multiple comorbidities. In such cases, transcatheter aortic valve implantation (TAVI) is a less invasive alternative. For screening of patients and preoperative planning, an anatomical approach to the aortic root and its adjacent structures is used; we observed incidental findings not dependent on the aorta. A thoracoabdominal computed angiotomography helps to evaluate such findings, the prevalence and relevance of which have not been well proven in our population.
Material and Methods: a retrospective study which examined incidental thoracoabdominal findings in 30 consecutive patients (21 men, 9 women; average age 78 years) with aortic stenosis who underwent a preoperative tomographic evaluation for transcatheter aortic valve implantation over a period of a year and a half. The incidental findings were reported and medical histories were reviewed to verify follow up.
Results: there were significant and insignificant incidental findings in 100% of the patients (30/30). Of the 115 incidental findings, 20 were significant (17.3%); 57 were abdominal (49.56%). Colonic diverticula were the most commonly reported finding in 15 of the 30 patients (50%). Thyroidal and pulmonary nodules were the most common significant findings, each reported in 7 of the 30 patients (23.3%).
Conclusions: due to the patients’ age and comorbidities, candidates for transcatheter aortic valve implantation have a high probability of incidental findings, predominantly abdominal. Some findings require follow up, mainly pleuropulmonary and extrapulmonary.

REFERENCES

1. Beyerbacht, H , Lamb H, Van der Laarse, A, et al. Aortic Valve Replacement in Patients with Aortic Valve Stenosis Improves Myocardial Metabolism and Diastolic Function. Radiology 2001;219:637-643.

2. Walther T, Simon P, Dewey T, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 2007;116(11 Suppl):240e245.

3. Noble S. Transapical aortic valve implantation: a reasonable therapeutic option, but not the only alternative to transfemoral approach. J Thorac Dis. 2013;5:360e361.

4. Lu TL, Huber CH, Rizzo E, Dehmeshki J, von Segesser LK, Qanadli SD. Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies. Eur Radiol. 2009;19:664e669.

5. Wieland Staab MDa,b,*, Leonard Bergau MDb,c, Joachim Lotz MDa,b, Christian Sohns MDb,c,d Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement Journal of Cardiovascular Computed Tomography 8 (2014) 222 e 229.

6. Siontis GC, Praz F, Pilgrim T et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur. Heart J 2016;37:3503-3512.

7. Schoenhagen P, Hausleiter J, Achenbach S, et al. Computed tomography in the evaluation for transcatheter aortic valve implantation (TAVI). Cardiovasc Diagn Ther. 2011;1:44-46.

8. Ben-Dor I, Waksman R, Hanna N, et al. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol. 2010;105:1461–1464.

9. Amira F. Hussien, MD, Jean Jeudy, MD,w Seth J. Kligerman, MD,w and Charles S. White, MDw Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI) J Thorac Imaging 2016;31:183-188.

10. Gufler H, Schulze CG, Wagner S. Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence? Acta radiol. 2014;55:420-426.

11. Apfaltrer P, Schymik G, Reimer P, et al. Aortoiliac CT angiography for planning transcutaneous aortic valve implantation: aortic root anatomy and frequency of clinically significant incidental findings. Am J Roentgenol. 2012;198:939-945.

12. Beyerbacht, H , Lamb H, Van der Laarse, A, et al. Aortic Valve Replacement in Patients with Aortic Valve Stenosis Improves Myocardial Metabolism and Diastolic Function. Radiology 2001;219:637-643.

13. Walther T, Simon P, Dewey T, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 2007;116(11 Suppl):240e245.

14. Noble S. Transapical aortic valve implantation: a reasonable therapeutic option, but not the only alternative to transfemoral approach. J Thorac Dis. 2013;5:360e361.

15. Lu TL, Huber CH, Rizzo E, Dehmeshki J, von Segesser LK, Qanadli SD. Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies. Eur Radiol. 2009;19:664e669.

16. Wieland Staab MDa,b,*, Leonard Bergau MDb,c, Joachim Lotz MDa,b, Christian Sohns MDb,c,d Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement Journal of Cardiovascular Computed Tomography 8 (2014) 222 e 229.

17. Siontis GC, Praz F, Pilgrim T et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur. Heart J 2016;37:3503-3512.

18. Schoenhagen P, Hausleiter J, Achenbach S, et al. Computed tomography in the evaluation for transcatheter aortic valve implantation (TAVI). Cardiovasc Diagn Ther. 2011;1:44-46.

19. Ben-Dor I, Waksman R, Hanna N, et al. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol. 2010;105:1461–1464.

20. Amira F. Hussien, MD, Jean Jeudy, MD,w Seth J. Kligerman, MD,w and Charles S. White, MDw Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI) J Thorac Imaging 2016;31:183-188.

21. Gufler H, Schulze CG, Wagner S. Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence? Acta radiol. 2014;55:420-426.

22. Apfaltrer P, Schymik G, Reimer P, et al. Aortoiliac CT angiography for planning transcutaneous aortic valve implantation: aortic root anatomy and frequency of clinically significant incidental findings. Am J Roentgenol. 2012;198:939-945.