Cardiac CT and Structural Heart Disease Interventions (Non-TAVI)

Purpose of review

The use of cardiac CT is well established in the TAVR sphere and gaining traction as an integral part of pre-procedural planning for left 13 atrial appendage closure (LAAC) and transcatheter mitral valve replacement (TMVR. We aim to review the recent evidence regarding the accuracy of cardiac CT for left atrial sizing and device selection and discuss the contribution of cardiac CT to decreasing complication rates in real-world experience as compared with clinical trials.

Recent findings

Pre-procedural CT imaging has evolved to become an integral part of LAA closure and TMVR. For LAA closure, CT imaging provides detailed anatomic assessment of the LAA and surrounding structures and accurate measurements for device sizing. These can facilitate device and equipment selection and enhance safety and outcomes with intraprocedural guidance with transesophageal echocardiography or intracardiac echocardiography. For TMVR, pre-procedural CT is necessary to assess the potential risk of LVOT obstruction and determine device sizing. Such assessments can help pre-plan the potential need for adjunctive strategies to lower the risk of LVOT obstruction.

Summary

CT imaging has gained important roles in the field of structural interventions, and understanding how to utilize this tool is an important skill to acquire as a contemporary comprehensive interventionist. Pre-procedural CT imaging has evolved to become an integral part of LAA closure and TMVR.