CT Imaging Requirements for MICS MVR

Critical Vascular Assessment

The American College of Cardiology recommends measuring ascending aortic diameter, which must be <4 cm if endoaortic balloon occlusion is planned, as complete occlusion becomes inconsistent in larger aortas 1
Assessing atheroma burden, including degree, location, and plaque characteristics, throughout the ascending aorta is essential for minimizing stroke risk and optimizing surgical planning 1
Evaluating iliac arteries for aneurysm, tortuosity, plaque burden, and any localized dissection or pseudoaneurysm from previous catheterization sites is crucial for peripheral arterial assessment 1
Measuring common femoral artery diameter and identifying the bifurcation point is necessary to determine the optimal cannulation site 1

Evaluating the degree and location of mitral annular calcification is vital, as significant calcification is a relative contraindication for MICS MVR in inexperienced surgeons due to increased risk of atrioventricular disruption 1
Ruling out aberrant anatomy, including patent ductus arteriosus, persistent left superior vena cava, and aberrant right subclavian artery, is essential for great vessel variants assessment 1

Identifying the optimal working port location relative to the pulmonary hilum, typically the fourth intercostal space, is crucial for chest wall and thoracic anatomy assessment 1
Assessing chest wall deformities, including kyphoscoliosis and pectus excavatum, is necessary to predict exposure challenges 1

Quantifying total atherosclerotic burden in the aorta and great vessels is essential, as significant atheroma increases stroke risk and may make MICS MVR less ideal 1
Assessing coronary artery anatomy, if coronary CT angiography is performed, particularly left main ostium location relative to planned aortic occlusion, is recommended 3

Failure to obtain contrast-enhanced CT can lead to limited vascular detail and may miss critical atherosclerotic disease, according to the American Heart Association 1
Inadequate imaging of peripheral vessels can complicate cannulation site planning, emphasizing the need for imaging to extend through the femoral bifurcation 1

Echocardiography remains essential for assessing aortic atheroma in conjunction with chest CT, as some soft plaques may be better visualized with ultrasound, as stated by the American Society of Echocardiography 1