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Pre-TAVI CT Planning - Coronary Height — EECC MCQ

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ModerateCardiac ImagingPre-TAVI CT Planning - Coronary HeightEECC

A 60-year-old woman scheduled for TAVI undergoes pre-procedural cardiac CT. The CT report describes the aortic annulus dimensions, coronary heights, peripheral vascular access, and notes a low left main coronary height of 9 mm. What is the clinical significance of this finding?

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Correct answer: E — Increased risk of coronary obstruction during TAVI; a low coronary height (<10-12 mm) requires careful valve selection and consideration of coronary protection strategies

Pre-TAVI cardiac CT is mandatory for procedural planning. Low coronary ostial height (<10-12 mm from the annulus plane to the coronary ostium) is a risk factor for coronary obstruction during TAVI, as the displaced native calcified leaflets can occlude the coronary ostia. This risk is higher with self-expanding valves, narrow sinuses of Valsalva, and bulky leaflet calcification. When coronary obstruction risk is identified, strategies include: chimney stenting (pre-positioning a guide wire or stent in the coronary artery), commissural alignment of self-expanding valves, or using a BASILICA technique (intentional leaflet laceration). The 2025 ESC VHD Guidelines emphasise the importance of CT planning to identify and mitigate this risk.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease