Читать книгу Interventional Cardiology - Группа авторов - Страница 279

CMR has evolved to play a pivotal role in TAVR planning [100]. Direct comparison of CMR and CTA measurements of the aortic root and aortic annulus has shown close agreement [101–103]. CMR is extremely useful in patients with renal insufficiency that are unable to undergo contrast‐enhanced CT. A gated non‐enhanced MRA serves as an alternative for accurate measurements of the aortic root, proximal aorta, LV function and evaluation of the aorto‐iliofemoral system [74,75]. [104, 105] PCVM can be used to quantify the severity of concomitant mitral or aortic regurgitation. The major limitation of CMR is inadequate visualization of aortic calcification [100].

CMR is also important in the evaluation of paravalvular leak (PVL) post‐TAVR. It has much lower interobserver variability in the evaluation of PVL as compared to echocardiography [106, 107] and severity of PVL on CMR has been shown to be associated with increased mortality [108].

Both MSCT and CVR techniques can be utilized in combination in “no contrast” imaging for certain preprocedure planning in patients with severe renal failure. For example, a non‐contrast gated MSCT of the aortic valve/annulus and the aortoiliac arterial beds can be combined with non contrast cardiac MR and no‐contrast MR‐angiogram of aortoiliac segments to assess sizing and calcification extent in TAVR planning.