Challenging Anatomic and Pathologic Features for Transcatheter Aortic Valve Replacement Planning

Segmentation and processing of CT datasets for transcatheter aortic valve replacement (TAVR) planning is now an essential part of the transcatheter heart valve team process. Output for TAVR planning includes geometric and pathologic findings of the aortic valve, root, and left ventricular outflow tract. In addition, access route selection requires assessment of the size and course of the access vessel and identification of any associated variant anatomic or pathologic conditions that could affect the procedure. Spurious or erroneous output from three-dimensional processing software can occur, especially with gradient-based segmentation algorithms. Identification and correction of these processing errors is imperative for accurate TAVR planning output. The authors review specific considerations for each anatomic region in which TAVR planning is needed and outline processing tips for providing high-quality planning output.