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Chen Y, Zhao J, Liu Q, Zhang H, Wang M, Niu G, Feng D, Lv B, Xu H, Song G, Wu Y. Computed tomography anatomical characteristics based on transcatheter aortic valve replacement in aortic regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2063-2071. [PMID: 37421576 DOI: 10.1007/s10554-023-02908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
This study analyzed computed tomography (CT) measurement characteristics and anatomical classifications based on transcatheter aortic valve replacement (TAVR) in patients with aortic regurgitation (AR) to establish a preliminary summary of CT anatomical characteristics and to design a novel self-expanding transcatheter heart valve (THV). This single-center retrospective cohort study included 136 patients diagnosed with moderate-to-severe AR at Fuwai Hospital from July 2017 to April 2022. Patients were classified into four anatomical classifications according to dual-anchoring multiplanar measurement of where THV anchoring took place. Types 1-3 were considered candidates for TAVR, whereas type 4 was not. Among 136 patients with AR, there were 117 (86.0%) tricuspid, 14 bicuspid, and five quadricuspid valves. Dual-anchoring multiplanar measurement showed that the annulus was smaller than left ventricular outflow tract (LVOT) at 2, 4, 6, 8, and 10 mm on the annulus. The ascending aorta (AA) 40 mm was wider than AA 30 mm and AA 35 mm, but narrower than AA 45 mm and AA 50 mm. For 10% oversize of the THV, the proportions of the annulus, LVOT, and AA unable to meet the diameter were 22.8%, 37.5%, and 50.0%, respectively, and the proportions of anatomical classification types 1-4 were 32.4%, 5.9%, 30.1%, and 31.6%, respectively. The novel THV could significantly improve the type 1 proportion (88.2%). Existing THVs cannot meet the anatomical characteristics of patients with AR. Conversely, based on anatomical characteristics, the novel THV could theoretically facilitate TAVR.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Qingrong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Guannan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Dejing Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing, 100037, China.
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Gogia S, Vahl TP, Thourani VH, Yadav PK, George I, Kodali SK, Hamid N, Ranard L, Chen T, Matsumura M, Maehara A, Treede H, Baldus S, Daniels D, Sheridan BC, Zahr F, Russo MJ, McCabe JM, Chetcuti SJ, Leon MB, Makkar RR, Khalique OK. Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation. STRUCTURAL HEART 2023. [DOI: 10.1016/j.shj.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Chen Y, Ferdous MM, Kottu L, Zhao J, Zhang HL, Wang MY, Niu GN, Liu QR, Zhou Z, Zhao ZY, Zhang Q, Feng DJ, Zhang B, Li ZA, Merkus D, Lv B, Xu HY, Song GY, Wu YJ. Can Measuring the 'Dual Anchors of Aorta' Enhance the Success Rate of TAVR?-A Single-Center Experience. J Clin Med 2023; 12:jcm12031157. [PMID: 36769804 PMCID: PMC9918180 DOI: 10.3390/jcm12031157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study's primary goal was to provide an initial summary of the medium- and short-term clinical effectiveness of transcatheter aortic valve replacement (TAVR) guided by accurate multi-detector computed tomography (MDCT) measurements in patients with severe and chronic AR, especially in elderly patients. METHODS The study enrolled retrospectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital, Beijing. Baseline information, MDCT measurements, anatomical classification, perioperative, and 1-year follow-up outcomes were collected and analyzed. Based on a novel anatomical categorization and dual anchoring theory, patients were divided into four categories according to the level of anchoring area. Type 1, 2, and 3 patients (with at least two anchoring regions) will receive TAVR with a transcatheter heart valve (THV), but Type 4 patients (with zero or one anchoring location) will be deemed unsuitable for TAVR and will instead receive medical care (retrospectively enrolled patients who already underwent TAVR are an exception). RESULTS The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years, and 23 patients (62.2%) were male. The American Association of Thoracic Surgeons' score was 8.6 ± 2.1%. The MDCT anatomical classification included 17 cases of type 1 (45.9%), 3 cases of type 2 (8.1%), 13 cases of type 3 (35.1%), and 4 cases of Type 4 (10.8%). The VitaFlow valve (MicroPort, Shanghai, China) was implanted in 19 patients (51.3%), while the Venus A valve (Venus MedTech, Hangzhou, China) was implanted in 18 patients (48.6%). Immediate TAVR procedural and device success rates were 86.5% and 67.6%, respectively, while eight cases (21.6%) required THV-in-THV implantation, and nine cases (24.3%) required permanent pacemaker implantation. Univariate regression analysis revealed that the major factors affecting TAVR device failure were sinotubular junction diameter, THV type, and MDCT anatomical classification (p < 0.05). Compared with the baseline, the left ventricular ejection fraction gradually increased, while the left ventricular end-diastolic diameter remained small, and the N-terminal-pro hormone B-type natriuretic peptide level significantly decreased within one year. CONCLUSION According to the results of our study, TAVR with a self-expanding THV is safe and feasible for patients with chronic severe AR, particularly for those who meet the criteria for the appropriate MDCT anatomical classification with intact dual aortic anchors, and it has a significant clinical effect for at least a year.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Md Misbahul Ferdous
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Lakshme Kottu
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Hong-Liang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Mo-Yang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guan-Nan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qing-Rong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zheng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zhen-Yan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qian Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - De-Jing Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zi-Ang Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Daphne Merkus
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University München, 81377 Munich, Germany
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Hai-Yan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guang-Yuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Yong-Jian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
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Sassis L, Kefala-Karli P, Cucchi I, Kouremenos I, Demosthenous M, Diplaris K. Valve Repair in Aortic Insufficiency: A State-of-the-art Review. Curr Cardiol Rev 2023; 19:e270422204131. [PMID: 35490315 PMCID: PMC10201877 DOI: 10.2174/1573403x18666220427120235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.
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Affiliation(s)
| | | | - Irene Cucchi
- University of Nicosia, School of Medicine, Nicosia, Cyprus
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Siani A, Perone F, Costantini P, Rodolfi S, Muscogiuri G, Sironi S, Carriero S, Pavon AG, van der Bilt I, van Rosendael P, Broekhuizen L, Teske A, Cramer MJ, Guglielmo M. Aortic regurgitation: A multimodality approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1041-1050. [PMID: 36218214 PMCID: PMC9828136 DOI: 10.1002/jcu.23299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
Aortic regurgitation (AR) is a common valvular pathology. Multimodality noninvasive cardiovascular imaging is routinely used to assess the mechanism of AR, degree, and its hemodynamic impact on the cardiovascular system. Collecting this information is crucial in establishing the prognosis and in guiding patient management and follow-up. While echocardiography remains the primary test to assess AR, a comprehensive assessment of this valvulopathy can be obtained by combining the information from different techniques. This state-of-the-art review is intended to provide an update ed overview of the applications, strengths, and limits of transthoracic echocardiography, cardiac magnetic resonance, and cardiac computed tomography in patients with AR.
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Affiliation(s)
- Agnese Siani
- Radiology DepartmentOspedale Maggiore della Carità University HospitalNovaraItaly
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa delle Magnolie", Castel MorroneCasertaItaly
| | - Pietro Costantini
- Radiology DepartmentOspedale Maggiore della Carità University HospitalNovaraItaly
| | - Sara Rodolfi
- Radiology DepartmentOspedale Maggiore della Carità University HospitalNovaraItaly
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano‐BicoccaMilanItaly
- Department of RadiologyIRCCS Istituto Auxologico Italiano, San Luca HospitalMilanItaly
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano‐BicoccaMilanItaly
- Department of RadiologyASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di MilanoMilanItaly
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero CantonaleLuganoSwitzerland
| | - Ivo van der Bilt
- Department of CardiologyHaga Teaching HospitalThe HagueNetherlands
| | - Philippe van Rosendael
- Department of Cardiology, Division of Heart and LungsUtrecht University, Utrecht University Medical CenterUtrechtThe Netherlands
| | - Lysette Broekhuizen
- Department of Cardiology, Division of Heart and LungsUtrecht University, Utrecht University Medical CenterUtrechtThe Netherlands
| | - Arco Teske
- Department of Cardiology, Division of Heart and LungsUtrecht University, Utrecht University Medical CenterUtrechtThe Netherlands
| | - Maarten Jan Cramer
- Department of Cardiology, Division of Heart and LungsUtrecht University, Utrecht University Medical CenterUtrechtThe Netherlands
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and LungsUtrecht University, Utrecht University Medical CenterUtrechtThe Netherlands
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Choe J, Koo HJ, Kang JW, Kim JB, Kang HJ, Yang DH. Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement. Sci Rep 2021; 11:21005. [PMID: 34697359 PMCID: PMC8549004 DOI: 10.1038/s41598-021-00406-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/05/2021] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52-0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea
| | - Joon Bum Kim
- Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jun Kang
- Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil, 88, Song-pa gu, Seoul, 05505, South Korea.
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Park SJ, Rhee Y, Lee CH, Kim HJ, Kim JB, Choo SJ, Lee JW. 3-Dimensional computed tomographic assessment predicts conduction block and paravalvular leakage after rapid-deployment aortic valve replacement. Eur J Cardiothorac Surg 2021; 61:899-907. [PMID: 34687534 DOI: 10.1093/ejcts/ezab431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/30/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Complications like complete atrioventricular block (CAVB) and paravalvular leakage (PVL) following rapid deployment aortic valve (AV) replacement (RDAVR) remain unresolved. Selecting an optimal size of the valve might be important to minimize the incidence of these complications. We sought to determine the impact of prosthesis size relative to the anatomic profile of the AV on the occurrence of CAVB or PVL after RDAVR. METHODS Preoperative computed tomographic (CT) images were evaluated in patients receiving RDAVR (INTUITY ELITE) between February 2016 and December 2019. The occurrence of CAVB requiring permanent pacemaker implantation and PVL (≥ mild) was evaluated. The relative size of implants against the cross-sectional dimensions of recipients' AV annulus and left ventricular outflow tract (LVOT) were calculated. RESULTS Among 187 eligible patients, CAVB and PVL (≥ mild) occurred in 12 (6.4%) and 11 patients (5.9%), respectively. CAVB was associated with oversized RDAVR (RDAVR frame width minus average diameter of LVOT calculated from the cross-sectional area [ΔLVOTarea]: odds ratio, 2.05; 95% confidence interval, 1.28-3.30): this was with an area under the curve of 0.78 (P = 0.005). The projected probability of CAVB was <3% when the ΔLVOTarea was <1.3. In contrast, PVL was associated with under-sized RDAVR (RDAVR size divided by the longest diameter of AV annulus [index Annlong]: odds ratio, 0.64; 95% confidence interval, 0.51-0.79): This was with an area under curve of 0.94 (P < 0.001). CONCLUSIONS CT parameters of the AV annulus and LVOT are highly reliable in the prediction of CAVB or PVL after RDAVR. Our data might justify CT-based sizing of prosthesis for RDAVR.
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Affiliation(s)
- Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Younju Rhee
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Chee-Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ahn Y, Koo HJ, Lee S, Kim DH, Song JM, Kang DH, Song JK, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Kang JW, Yang DH. Preoperative Cardiac Computed Tomography Characteristics Associated with Recurrent Aortic Regurgitation after Aortic Valve Re-Implantation. Korean J Radiol 2020; 21:181-191. [PMID: 31997593 PMCID: PMC6992440 DOI: 10.3348/kjr.2019.0446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022] Open
Abstract
Objective To identify the preoperative cardiac computed tomography (CT) factors influencing postoperative recurrent aortic regurgitation (AR) in patients who underwent aortic valve repair with the re-implantation technique (David operation) due to AR. Materials and Methods A total of 117 patients (age, 49.4 ± 15.6 years; 83 males) who underwent the David operation for AR were included in this retrospective study. Aortic root profiles including the aortic regurgitant orifice area (ARO) and the aortic cusp asymmetry ratio of the areas (ASRarea), which is defined as the maximum/minimum areas among the three cusp areas at the level of the commissures, were measured on preoperative cardiac CT scans. Clinical and CT findings were compared between a group with recurrent AR grade < 3 (no, trivial, or mild AR) and recurrent ≥ 3 + AR. To determine the optimal cut-off values of ASR and ARO, the receiver operating characteristic (ROC) curve was used. Cox regression analysis was used for the analysis of the factors affecting recurrent 3 + AR. Results Postoperatively, recurrent 3 + AR developed in 17 (14.5%) patients and occurred within a median of 268 days (interquartile range: 78–582 days). The cut-off ARO value for discriminating the patients with recurrent 3 + AR was > 24 mm2 (sensitivity, 76.5%; specificity 64.8%), and the area under the ROC curve (AUC) was 0.72. For ASRarea, the cut-off value was > 1.58 (sensitivity, 76.5%; specificity, 58.0%) and the AUC was 0.64. Multivariable Cox regression showed that ARO > 24 mm2 (hazard ratio = 3.79, p = 0.020) was a potential independent parameter for recurrent 3 + AR. ROC for the linear regression model showed that the AUC for both ARO and ASRarea was 0.73 (95% confidence interval, 0.64–0.81, p < 0.001). Conclusion ARO and ASRarea detected on preoperative cardiac CT would be potentially helpful for identifying AR patients who may benefit from the David operation.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Ho Jung
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Kim HJ, Park SJ, Koo HJ, Kang JW, Yang DH, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Determinants of effective orifice area in aortic valve replacement: anatomic and clinical factors. J Thorac Dis 2020; 12:1942-1951. [PMID: 32642097 PMCID: PMC7330291 DOI: 10.21037/jtd-20-188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Obtaining adequate effective orifice area (EOA) in surgical aortic valve replacement (SAVR) is important to minimize pressure gradients across the prosthetic aortic valve (AV) and improve clinical outcomes. However, the predictors of EOA are unclear. Methods From July 2011 to March 2016, patients undergoing SAVR who were preoperatively evaluated using a computed tomography (CT) on the aortic root were enrolled. Indexed EOA (iEOA) was used as an indicator of prosthetic AV opening area. The aortic root parameters investigated were the annular diameter (max and min), annular perimeter, annular area, and maximal dimensions of the proximal ascending aorta. These variables were evaluated as predictors of EOA, and an individual surgeon was incorporated in analysis for verifying surgeon dependent factors. Results Among the 710 patients included in this study [age: 64.9±10.8 years; females: n=285 (40.1%)], 370 (52.1%) were implanted with bio-prosthesis. Mean prosthetic iEOA was 1.1±0.3 cm2/m2. Univariable linear regression analysis showed that all indexed aortic root parameters (maximal and minimal annular diameters, annular perimeter, annular area, and sinus dimensions) were significantly associated with iEOA (P<0.001). Multivariable analysis showed that indexed aortic annular area, indexed maximal diameter of the Valsalva sinus, female sex, and bio-prosthesis, supra-annular type prosthesis and surgeon were significant and independent determinants of iEOA (adjusted R2=0.513, P<0.001). Conclusions Aortic annular area and Valsalva sinus diameter are independent determinants for iEOA measured by preoperative CT; surgeon-dependent factors are also significant determinants in SAVR.
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Affiliation(s)
- Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Koo HJ, Kang JW, Oh SY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Yang DH. Cardiac computed tomography for the localization of mitral valve prolapse: scallop-by-scallop comparisons with echocardiography and intraoperative findings. Eur Heart J Cardiovasc Imaging 2018; 20:550-557. [DOI: 10.1093/ehjci/jey139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/07/2018] [Indexed: 12/07/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
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12
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Yang DH, Park SH, Lee K, Kim T, Kim JB, Yun TJ, Kim GB, Kim N. Applications of Three-Dimensional Printing in Cardiovascular Surgery: A Case-Based Review. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Hyub Park
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Koeun Lee
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taehun Kim
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Medical Imaging and Intelligent Reality Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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