Article information
Resumo
A substituição valvular aórtica percutânea é uma opção emergente para o tratamento da estenose aórtica grave sintomática em doentes recusados para substituição valvular cirúrgica. Os autores fazem uma revisão da literatura na utilização da Tomografia Computorizada Multicorte na avaliação de candidatos a implantação de prótese aórtica percutânea, no apoio ao procedimento e seguimento pós-intervenção. Os autores descrevem, ainda, a experiência de um Centro na utilização desta técnica de imagem no contexto de substituição valvular aórtica percutânea.
A Tomografia Computorizada Multicorte é um método de imagem de eleição na selecção e exclusão de candidatos a implantação valvular aórtica percutânea, permitindo avaliação da anatomia coronária e relação dos ostia coronários com a estrutura valvular aórtica, avaliação precisa do anel valvular e restante raiz aórtica, câmara de saída do ventrículo esquerdo, aorta e acessos vasculares periféricos. As imagens obtidas por Tomografia Computorizada Multicorte são informação central na escolha da dimensão da prótese a implantar, permitem apoio à punção vascular durante o procedimento por métodos de fusão de imagem e efectuar seguimento à adequada aposição da prótese.
Palavras-chave:
Estenose aórtica grave
Substituição valvular aórtica percutânea
Tomografia Computorizada Multicorte
Abstract
Transcatheter aortic valve implantation is an emerging treatment option for severe symptomatic aortic stenosis in patients considered unsuitable for surgical valve replacement. The authors review the use of multislice computed tomography in the selection of candidates for transcatheter aortic valve replacement, procedural support and post-interventional follow-up. A single-center experience of the role of this imaging technique is also described.
Multislice computed tomography is an essential imaging tool in the selection and exclusion of candidates for transcatheter aortic valve implantation, providing evaluation of coronary anatomy and the relationship of the coronary ostia with the aortic valve structure, and accurate analysis of the valve annulus and aortic root, left ventricular outflow tract, aorta and peripheral vascular access routes. Multislice computed tomography is also central to the choice of appropriate prosthesis size. In addition, it guides arterial puncture by image fusion techniques and enables correct prosthesis apposition to be verified. This review aims to describe the role of computed tomography in this increasingly common interventional valve procedure, providing an overview of current knowledge and applications.
Keywords:
Severe aortic stenosis
Transcatheter aortic valve implantation
Multislice computed tomography
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