Cardiac Imaging Pearls in Bicuspid AS
From EuroIntervention:
eurointervention.pcronline.c…
1️⃣ CT is King for BAV TAVR
•Essential for defining raphe, leaflet morphology, calcium burden, annular shape, and ascending aorta size.
•Identify heavy/rigid raphe → predicts expansion issues PVL risk.
2️⃣ Measure More Than the Annulus
•BAV = elliptical, asymmetric.
•Consider supra-annular sizing or “virtual raphe ring” when annulus doesn’t tell the whole story.
3️⃣ Calcium Mapping Matter
•High calcium → higher risk of malexpansion, rupture, stroke.
4️⃣ Delineate the Aorta
•BAV often comes with root & ascending aorta dilation.
•CT aortography crucial for deciding TAVR vs SAVR when aortopathy present.
5️⃣ Coronary Heights in BAV Are Tricky
•Asymmetric cusp fusion can distort coronary takeoff. High/ eccentric take off
•Carefully assess coronary height sinus size.
6️⃣ Echo Complements CT
•TTE: Hemodynamics, gradient confirmation, LV function, AR degree.
•TEE: Intra-procedural alignment & PVL detection especially in challenging anatomy.
7️⃣ Post-TAVR Imaging is Not Optional
•BAV valves may expand asymmetrically → follow-up echo ± CT for durability and PVL assessment.
#Echofirst #YesCCT #CVimaging