Pre-operative aortic valve implantation evaluation: multimodality imaging.

Transcatheter aortic valve implantation procedures have been one of the main therapeutic breakthroughs of the last decade providing a feasible alternative therapy to patients with severe symptomatic aortic stenosis and high operative risk. To date, more than 10,000 patients have been treated with this novel therapy and promising results, using either a transarterial or transapical approach have been reported. Accurate preprocedural evaluation of candidates for TAVI is crucial to optimise the success rate and minimise the procedure-related complications. Multimodality imaging plays a central role in the preprocedural evaluation of these patients and provides valuable information on aortic stenosis severity, aortic valve anatomy, aortic valve annular dimensions and peripheral vascular anatomy, key issues to accurately select the prosthesis size and the procedural approach (transarterial vs. transapical). A combination of 2- and 3-dimensional echocardiography and multi-detector row computed tomography or magnetic resonance imaging may provide the most comprehensive approach to accurately evaluate these patients. The present article reviews the role of multimodality imaging before the TAVI procedure and provides a practical guide to evaluate patients who are candidates for TAVI.