Cardiovascular magnetic resonance facilitates entirely contrast-free transcatheter aortic valve implantation: case report

Journal article

Background

Transcatheter aortic valve implantation (TAVI) is usually planned using contrast-enhanced computed tomography (CT) to determine the suitability of cardiovascular anatomy. Computed tomography for TAVI planning requires the administration of intravenous contrast, which may not be desirable in patients with severely reduced renal function.

Case summary

We present an unusual case of an 89-year-old patient with an urgent need for treatment of critical, symptomatic aortic stenosis who also had severe chronic kidney disease. We judged that this posed a relative contraindication to the use of intravenous contrast. We designed and implemented a novel, contrast-free cardiovascular magnetic resonance (CMR) protocol and used this to plan all aspects of the procedure. Transcatheter aortic valve implantation was conducted successfully with zero contrast medium administration leading to an excellent clinical result and recovery of renal function.

Conclusion

Contrast-free CMR appears to be a viable alternative to CT for planning structural aortic valve intervention in the rare cases where intravenous contrast is relatively contraindicated.

Authors: Raby, J; Newton, JD; Dawkins, S; Lewis, AJM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: European Heart Journal: Case Reports
• Volume: 5
• Issue: 12
• Article number: ytab378
• Publication date: 2021-09-28
• Acceptance date: 2021-09-14
• DOI: 10.1093/ehjcr/ytab378
• EISSN: 2514-2119
• Language: English
• Keywords: intervention; imaging; aortic valve; case report; FFR; magnetic resonance imaging