Cardiac Imaging in Transcatheter Treatment of Valvular Heart Disease

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 1.75
Procedures: 1.75
Interventional Procedures: 1.75

Computed Tomography: 1.00
Procedures: 1.00
Neck and Chest: 1.00

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Thoracic Section: 1.75

Outline

1. Introduction
2. Transcatheter Aortic Valve Replacement
   1. Annulus
   2. Aortic Root
   3. Aortic Valve Morphologic Characterisitcs
   4. Calcium Distribution
   5. Additional Anatomic Measurements for TAVR
   6. Catheter Access Route
3. Transcatheter Mitral Valve Repair
4. Transcatheter Mitral Valve Replacement
   1. Mitral Valve Evaluation before Transcatheter Replacement
   2. Neo-LVOT Characterization and Risk of LVOT Obstruction
5. Transcatheter Tricuspid Valve Interventions
6. Novel Cardiovascular Imaging Techniques
7. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the key roles for multimodality imaging in the diagnosis and treatment of both coronary and structural heart disease
2. be familiar with the commonality of aortic valve stenosis
3. recognize the imaging modality of choice for preprocedural TAVR planning
4. recognize the measured parameters at CT angiography at the level of the aortic root
5. be familiar with the imaging-derived predictive factor for annular rupture in TAVR
6. be familiar with the approved transcatheter aortic replacement devices
7. be familiar with the measurements associated with a higher risk of coronary artery occlusion
8. identify the first diagnostic test obtained in the assessment of valvular disease
9. be familiar with the classifying factors for bicuspid morphology
10. be familiar with the clinical trials conducted on TAVR outcomes
11. understand the benefits of using optimal fluoroscopic projection while performing TAVR
12. identify the artery typically used for performing TAVR
13. identify the CE-approved transcatheter mitral valve repair devices
14. recognize the FDA-approved transcatheter mitral valve repair device
15. be familiar with the indirect devices used for mitral valve repair
16. be familiar with the utilization of Cardioband for mitral valve repair
17. identify the views necessary for preprocedural cardiac CT assessment of the mitral valve apparatus for planning percutaneous edge-to-edge repair
18. be familiar with the use of MitraClip
19. identify the CT artifacts in the setting of annular calcification
20. be familiar with the acronym of TMVR
21. be familiar with the D-shape annulus image used for TMVR
22. be familiar with the scoring system developed by Guerrero et al
23. recognize the risks associated with LVOT obstruction
24. be familiar with the projected area measurements associated with high risk LVOT obstruction
25. be familiar with the use of transthoracic echocardiography for repair or replacement of the tricuspid valve
26. be familiar with the criteria for assessing tricuspid regurgitation
27. identify valuable CT information used for planning tricuspid valve interventions
28. be familiar with the predicted anchor position in CT imaging
29. be familiar with the dynamic imaging factors for measuring the tricuspid annulus
30. be familiar with advanced visualization techniques for imaging structural heart disease
31. recognize the main imaging modalities used for assessments for structural heart interventions
32. be familiar with the characteristics of virtual reality
33. be familiar with the potential advantages of 4D imaging
34. be familiar with the algorithms that will potentially improve accuracy and reliability of image-based diagnosis
35. be familiar with the use of mixed reality imaging