1
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Wang X, Chen F, Xiong TY, Li YJ, Ou YW, Li Q, Peng Y, Wei JF, He S, Chen M, Feng Y. A CT-based technique to predict optimal projection for self-expanding TAVI in patients with different aortic valve anatomies. BMC Cardiovasc Disord 2021; 21:590. [PMID: 34876008 PMCID: PMC8650525 DOI: 10.1186/s12872-021-02387-7] [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: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Optimal projection is essential for valve deployment during transcatheter aortic valve implantation (TAVI). The purpose of this study was to propose an approach to predict optimal projection in TAVI candidates with different aortic valve anatomies. Methods 331 patients undergoing self-expanding TAVI were included and the so-called non-coronary cusp (NCC)-parallel technique was utilized, which generated the predicted projection by connecting NCC commissures on the transverse plane on the pre-procedural computed tomography images. Results 37.8% of the study cohort were bicuspid aortic valve (BAV) patients. Around 80% of both NCC-parallel views and final views were in the right anterior oblique (RAO) and caudal (CAU) quadrant. There was less than 5° change required from the NCC-parallel view to the final implanted view in 79% of tricuspid aortic valve (TAV) patients but only in 27% (13/48) of type 0 BAV patients with coronary arteries originated from the different cusps. After excluding the above mentioned BAV patients, 62.3% (48/77) of BAV patients needed less than 5° change to achieve optimal projection and only in 8 patients, the angular change was larger than 10° in either left/right anterior oblique or cranial/caudal direction. Conclusions The NCC-parallel technique provides reliable prediction for optimal projection in self-expanding TAVI in all TAV and most BAV patients, with a vast majority of views in the RAO and CAU quadrant. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02387-7.
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Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuan-Weixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jia-Fu Wei
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Sammour Y, Banerjee K, Kumar A, Lak H, Chawla S, Incognito C, Patel J, Kaur M, Abdelfattah O, Svensson LG, Tuzcu EM, Reed GW, Puri R, Yun J, Krishnaswamy A, Kapadia S. Systematic Approach to High Implantation of SAPIEN-3 Valve Achieves a Lower Rate of Conduction Abnormalities Including Pacemaker Implantation. Circ Cardiovasc Interv 2021; 14:e009407. [PMID: 33430603 DOI: 10.1161/circinterventions.120.009407] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The conventional method of implanting balloon-expandable SAPIEN-3 (S3) valve results in a final 70:30 or 80:20 ratio of the valve in the aorta:left ventricular outflow tract with published rates of permanent pacemaker around 10%. We sought to evaluate whether higher implantation of S3 reduces conduction abnormalities including the need for permanent pacemaker. METHODS We included consecutive patients who underwent transfemoral transcatheter aortic valve replacement using S3 between April 2015 and December 2018 and compared outcomes with typical valve deployment strategy to our more contemporary high deployment technique (HDT). We excluded patients with nontransfemoral access or valve-in-valve. RESULTS Among 1028 patients, HDT was performed in 406 patients (39.5%). Mean implantation depth under the noncoronary cusp was significantly smaller with HDT compared with conventional technique (1.5±1.6 versus 3.2±1.9 mm; P<0.001). Successful implantation was achieved in 100% of the patients in both groups with no cases of conversion to open heart surgery, second valve implantation within the first transcatheter aortic valve replacement, or coronary occlusion during transcatheter aortic valve replacement. One patient (0.2%) had valve embolization with HDT (P=0.216). Thirty-day permanent pacemaker rates were lower with HDT (5.5% versus 13.1%; P<0.001), as were rates of complete heart block (3.5% versus 11.2%; P<0.001) and new-onset left bundle branch block (5.3% versus 12.2%; P<0.001). There were no differences in mild (16.5% versus 15.9%; P=0.804), or moderate-to-severe aortic regurgitation (1% versus 2.7%; P=0.081) at 1 year. HDT was associated with slightly higher 1-year mean gradients (13.1±6.2 versus 11.8±4.9 mm Hg; P=0.042) and peak gradients (25±11.9 versus 22.5±9 mm Hg; P=0.026). However, Doppler velocity index was similar (0.47±0.15 versus 0.48±0.13; P=0.772). CONCLUSIONS Our novel technique for balloon-expandable S3 valve positioning consistently achieves higher implantation resulting in substantial reduction in conduction abnormalities and permanent pacemaker requirement after transcatheter aortic valve replacement without compromising procedural safety or valve hemodynamics. Operators should consider this as an important technique to improve patient outcomes.
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Affiliation(s)
- Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Hassan Lak
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Sanchit Chawla
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Jay Patel
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Manpreet Kaur
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Grant W Reed
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - James Yun
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
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3
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Visby L, Kristensen CB, Pedersen FHG, Sigvardsen PE, Kofoed KF, Hassager C, Møgelvang R. Assessment of left ventricular outflow tract and aortic root: comparison of 2D and 3D transthoracic echocardiography with multidetector computed tomography. Eur Heart J Cardiovasc Imaging 2020; 20:1156-1163. [PMID: 30879047 DOI: 10.1093/ehjci/jez045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS Accurate echocardiographic assessment of left ventricular outflow tract (LVOT) and the aortic root is necessary for risk stratification and choice of appropriate treatment in patients with pathologies of the aortic valve and aortic root. Conventional 2D transthoracic echocardiographic (TTE) assessment is based on the assumption of a circular shaped LVOT and aortic root, although previous studies have indicated a more ellipsoid shape. 3D TTE and multidetector computed tomography (MDCT) applies planimetry and are not dependent on geometrical assumptions. The aim was to test accuracy, feasibility, and reproducibility of 3D TTE compared to 2D TTE assessment of LVOT and aortic root areas, with MDCT as reference. METHODS AND RESULTS We examined 51 patients with 2D/3D TTE and MDCT at the same day. All patients were re-examined with 2D/3D TTE on a different day to evaluate 2D and 3D re-test variability. Areas of LVOT, aortic annulus, and sinus were assessed using 2D, 3D TTE, and MDCT. Both 2D/3D TTE underestimated the areas compared to MDCT; however, 3D TTE areas were significantly closer to MDCT-areas. 2D vs. 3D mean MDCT-differences: LVOT 1.61 vs. 1.15 cm2, P = 0.019; aortic annulus 1.96 vs. 1.06 cm2, P < 0.001; aortic sinus 1.66 vs. 1.08 cm2, P = 0.015. Feasibility was 3D 76-79% and 2D 88-90%. LVOT and aortic annulus areas by 3D TTE had lowest variabilities; intraobserver coefficient of variation (CV) 9%, re-test variation CV 18-20%. CONCLUSION Estimation of LVOT and aortic root areas using 3D TTE is feasible, more precise and more accurate than 2D TTE.
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Affiliation(s)
- Lasse Visby
- The Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | | | | | | | | | | | - Rasmus Møgelvang
- The Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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4
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Chamberlain RC, Ezekian JE, Sturgeon GM, Barker PCA, Hill KD, Fleming GA. Preprocedural three-dimensional planning aids in transcatheter ductal stent placement: A single-center experience. Catheter Cardiovasc Interv 2019; 95:1141-1148. [PMID: 31854085 DOI: 10.1002/ccd.28669] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/05/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Describe the use of three-dimensional (3D) patent ductus arteriosus (PDA) modeling to better define ductal anatomy to improve preprocedural planning for ductal stent placement. BACKGROUND Ductal stenting is an alternative to surgical shunting in patients with ductal dependent pulmonary blood flow. Ductal anatomy is often complex with extreme tortuosity and risk of pulmonary artery isolation, thus increasing procedural risks. METHODS CT angiograms were segmented to produce 3D PDA models. Ductal morphology was characterized with attention to access approach, degree of pulmonary artery offset/risk of isolation and ductal tortuosity. 3D models were retrospectively compared with biplane angiography. RESULTS 3D modeling was performed in 12 patients with adequate image quality for complete analysis in 11; median (interquartile range) age/weight 17 days (8-20 days) and 3.1 kg (2.4-3.9 kg). The PDA was reverse oriented in nine with average length of 17.2 ± 2.5 mm and high tortuosity (mean tortuosity index 52, range 3-108). From 3D modeling, two patients were excluded from ductal stenting-extreme ductal tortuosity and threatened pulmonary artery discontinuity, respectively. Ductal stenting was successful in the remaining nine with no major procedural complications. 3D modeling predicted a successful access approach based on the aortic orientation of the ductus in all patients (five carotid, two axillary, two femoral). When comparing 2D angiography with 3D models, angiography consistently underestimated ductal length (-3.2 mm ± 1.6 mm) and tortuosity (-14.8 ± 7.2). CONCLUSIONS 3D modeling prior to ductal stent placement for ductal dependent pulmonary blood flow is useful in procedural planning, specifically for eligibility, access approach, and accurate ductal measurements. Further studies are needed to determine if 3D planning improves procedural outcomes.
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Affiliation(s)
- Reid C Chamberlain
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jordan E Ezekian
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Gregory M Sturgeon
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Piers C A Barker
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Kevin D Hill
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Gregory A Fleming
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
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5
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Ng VG, Hahn RT, Nazif TM. Planning for Success: Pre-procedural Evaluation for Transcatheter Aortic Valve Replacement. Cardiol Clin 2019; 38:103-113. [PMID: 31753169 DOI: 10.1016/j.ccl.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivian G Ng
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA.
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6
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Ju MH, Oh SY, Choo SJ, Yang DH, Kang J, Kim JB, Shinn SH, Lee JW, Lim T. Three‐Dimensional Computed Tomographic Analysis of Normal and Aneurysmal Aortic Roots: Is There a Specific Geometric Pattern in the Aortic Root? Clin Anat 2019; 33:117-123. [DOI: 10.1002/ca.23482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/01/2019] [Accepted: 09/14/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Min Ho Ju
- Department of Thoracic and Cardiovascular Surgery Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Pusan South Korea
| | - Sang Young Oh
- Department of Radiology 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
| | - Dong Hyun Yang
- Department of Radiology Asan Medical Center, University of Ulsan College of Medicine Seoul South Korea
| | - Joon‐Won Kang
- Department of Radiology 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
| | - Sung Ho Shinn
- Department of Thoracic and Cardiovascular Surgery Cheju Halla General Hospital Jeju South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center, University of Ulsan College of Medicine Seoul South Korea
| | - Tae‐Hwan Lim
- Department of Radiology Asan Medical Center, University of Ulsan College of Medicine Seoul South Korea
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7
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Holper EM, Gopal D, Biberstein A, Filardo G, Avila A, Gopal A. Validation of a low-dose contrast 64-slice cardiac computed tomography angiography protocol for aortic valve annulus sizing. Proc (Bayl Univ Med Cent) 2019; 31:414-418. [PMID: 30948969 DOI: 10.1080/08998280.2018.1482515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022] Open
Abstract
Cardiac computed tomography angiography (CCTA) is the gold standard for accurately sizing the aortic valve annulus prior to aortic valve replacement. A reduction of contrast volume administered for CCTA, without sacrificing image quality, is desirable. Signal-to-noise ratio represents final CCTA image quality. Consecutive patients referred to CCTA for aortic valve annulus sizing were retrospectively analyzed. Patients were grouped into a low-dose contrast (LDCT) group and traditional dose contrast (TDCT) group. In the LDCT group, contrast dose was <50% of the maximal allowable dose (3.7 × estimated glomerular filtration rate). Guided by a time-density curve, the contrast was administered in a two-stage infusion, and retrospectively gated images were acquired with a 64-multidetector computed tomography scanner. Out of 123 patients (age 80 ± 9 years; 46% female), 65 (52.9%) underwent LDCT and 58 (47.2%) underwent TDCT. Contrast volume was significantly lower in the LDCT group (LDCT 41.2 ± 9.8 vs TDCT 76.2 ± 14.2 mL; P < 0.001). The signal-to-noise ratio of the aortic root was 10.4 ± 4.1 for the LDCT group and 8.4 ± 3.3 for the TDCT group (P = 0.004). Aortic root dimensions could be measured in both LDCT and TDCT groups. In conclusion, LDCT with 64-slice CCTA can effectively size the aortic valve annulus to direct aortic valve replacement while offering reduced contrast exposure.
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Affiliation(s)
- Elizabeth M Holper
- The Heart Hospital Baylor PlanoPlanoTexas.,Baylor Research InstitutePlanoTexas
| | | | | | - Giovanni Filardo
- The Heart Hospital Baylor PlanoPlanoTexas.,Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White HealthDallasTexas
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8
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Madukauwa-David ID, Midha PA, Sharma R, McLain K, Mitra R, Crawford K, Yoon SH, Makkar RR, Yoganathan AP. Characterization of aortic root geometry in transcatheter aortic valve replacement patients. Catheter Cardiovasc Interv 2018; 93:134-140. [DOI: 10.1002/ccd.27805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/27/2018] [Accepted: 07/12/2018] [Indexed: 11/12/2022]
Affiliation(s)
| | - Prem A. Midha
- Georgia Institute of Technology; Atlanta Georgia
- Exponent, Inc.; Philadelphia Pennsylvania
| | - Rahul Sharma
- Cedars-Sinai Heart Institute; Los Angeles California
| | - Kylee McLain
- Georgia Institute of Technology; Atlanta Georgia
| | | | | | - Sung-Han Yoon
- Cedars-Sinai Heart Institute; Los Angeles California
| | - Raj R. Makkar
- Cedars-Sinai Heart Institute; Los Angeles California
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9
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Goeddel LA, Abernathy JH, Brady MB. An Anesthesiologist's Guide to the 2017 American College of Cardiology Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis. J Cardiothorac Vasc Anesth 2018; 33:263-273. [PMID: 29935802 DOI: 10.1053/j.jvca.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Lee Andrew Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mary B Brady
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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10
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Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, Lee JC, Ruiz CE, Vassileva CM. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017; 69:1313-1346. [PMID: 28063810 DOI: 10.1016/j.jacc.2016.12.006] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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11
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Hecker F, Arsalan M, Walther T. Managing Stroke During Transcatheter Aortic Valve Replacement. Interv Cardiol 2017; 12:25-30. [PMID: 29588726 DOI: 10.15420/icr.2016:26:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become the default treatment option for high-risk patients with aortic stenosis and an alternative to surgical aortic valve replacement in intermediate-risk patients. There are, however, concerns regarding strokes during TAVR. Reported stroke rates vary strongly depending on the type of study, stroke definition, cohort and study period. Furthermore, stroke after TAVR occurs in three distinct phases: 1) early high-risk, directly procedure related; 2) elevated risk interval between day 2 and day 30; 3) late hazard interval. Each of these phases is caused by the different aetiologies of stroke. This review summarises the different aetiologies and potential strategies for managing stroke during TAVR.
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Affiliation(s)
- Florian Hecker
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Mani Arsalan
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
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12
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Plessis J, Warin Fresse K, Cahouch Z, Manigold T, Letocart V, Le Gloan L, Guyomarch B, Guerin P. Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts. J Am Heart Assoc 2016; 5:JAHA.115.002233. [PMID: 27287701 PMCID: PMC4937242 DOI: 10.1161/jaha.115.002233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coronary angiography is more complex in patients with coronary artery bypass grafts (CABG). Image fusion is a new technology that allows the overlay of a computed tomography (CT) three-dimension (3D) model with fluoroscopic images in real time. METHODS AND RESULTS This single-center prospective study included 66 previous CABG patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest CT scan with contrast was available. For patients in this group, aorta and CABG were reconstructed in 3D from CT acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the CABG; procedure duration; air kerma (AK); dose area product (DAP); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize CABG was significantly shorter in the fusion group (7.3 versus 12.4 minutes; P=0.002), as well as the procedure duration (20.6 versus 25.6 minutes; P=0.002), AK (610 versus 814 mGy; P=0.02), DAP (4390 versus 5922.5 cGy·cm(2); P=0.02), and volume of iodinated contrast media (85 versus 116 cc; P=0.002). CONCLUSIONS 3D image fusion improves the CABG detection in coronary angiography and reduces the time necessary to localize CABG, total procedure time duration, radiation exposure, and volume of contrast media.
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Affiliation(s)
- Julien Plessis
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karine Warin Fresse
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Zachary Cahouch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Thibaut Manigold
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Vincent Letocart
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laurianne Le Gloan
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Béatrice Guyomarch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Patrice Guerin
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
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13
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Natarajan N, Patel P, Bartel T, Kapadia S, Navia J, Stewart W, Tuzcu EM, Schoenhagen P. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovasc Diagn Ther 2016; 6:144-59. [PMID: 27054104 DOI: 10.21037/cdt.2016.02.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR.
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Affiliation(s)
- Navin Natarajan
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Parag Patel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Thomas Bartel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Samir Kapadia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Jose Navia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - William Stewart
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - E Murat Tuzcu
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Paul Schoenhagen
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
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Al-Mallah MH, Aljizeeri A, Villines TC, Srichai MB, Alsaileek A. Cardiac computed tomography in current cardiology guidelines. J Cardiovasc Comput Tomogr 2015; 9:514-23. [DOI: 10.1016/j.jcct.2015.09.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 01/06/2023]
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15
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Renapurkar RD, El-Sherief AH, Prieto L, Kapadia SR, Schoenhagen P. Transcatheter Structural Cardiac Intervention: A Radiology Perspective. AJR Am J Roentgenol 2015; 204:W648-W662. [DOI: 10.2214/ajr.14.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Rahul D. Renapurkar
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed H. El-Sherief
- Section of Thoracic Imaging, L10, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Lourdes Prieto
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Abstract
PURPOSE OF REVIEW This review provides an outline of recent applications related to the use of ultrasonography in various catheter-based procedures for the repair of many valvular abnormalities. RECENT FINDINGS Percutaneous interventions are becoming a safe and effective therapeutic modality in the management of various valvular defects. The intrinsic ability of ultrasound to provide real-time accurate assessment of cardiac and valvular structural and functional abnormalities makes this modality distinctively useful in the execution of percutaneous valvular procedures and evaluation of their results.Clinical applications of myocardial deformation and cardiac mechanics have been investigated in an increasing number of clinical applications. Speckle tracking accurately measures myocardial deformation parameters and has been recently applied to the evaluation of mitral insufficiency mechanisms. SUMMARY Recent developments in echocardiography are promoting this modality from its traditional role of diagnostic technique into one suitable for aiding in the execution of complex catheter-based procedures and for accurate monitoring of therapeutic response in many clinical settings.
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Loor G, Roselli EE. Imaging and minimally invasive aortic valve replacement. Ann Cardiothorac Surg 2015; 4:62-6. [PMID: 25694979 DOI: 10.3978/j.issn.2225-319x.2014.11.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/07/2014] [Indexed: 01/22/2023]
Abstract
Cardiovascular imaging has been the most important tool allowing for innovation in cardiac surgery. There are now a variety of approaches available for treating aortic valve disease, including standard sternotomy, minimally invasive surgery, and percutaneous valve replacement. Minimally invasive cardiac surgery relies on maximizing exposure within a limited field of view. The complexity of this approach is increased as the relationship between the great vessels and the bony thorax varies between individuals. Ultimately, the success of minimally invasive surgery depends on appropriate choices regarding the type and location of the incision, cannulation approach, and cardioprotection strategy. These decisions are facilitated by preoperative imaging, which forms the focus of this review.
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Affiliation(s)
- Gabriel Loor
- 1 Division of Cardiothoracic Surgery, University of Minnesota Health, Minneapolis, Minnesota, USA ; 2 Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric E Roselli
- 1 Division of Cardiothoracic Surgery, University of Minnesota Health, Minneapolis, Minnesota, USA ; 2 Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Multidimensional MDCT angiography in the context of transcatheter aortic valve implantation. AJR Am J Roentgenol 2014; 203:749-58. [PMID: 25247940 DOI: 10.2214/ajr.13.12159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Transcatheter aortic valve implantation has emerged as a viable treatment alternative for patients with severe aortic stenosis who are not surgical candidates. Multidimensional (3D and 4D) MDCT angiography plays a critical role in the safety, success, and outcome of an institutional transcatheter aortic valve implantation program. CONCLUSION Given the increasing therapeutic role of this innovative technique, an understanding of essential imaging concepts in its context is critical for appropriate image acquisition and interpretation.
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Kim DH, Handschumacher MD, Levine RA, Sun BJ, Jang JY, Yang DH, Kang JW, Song JM, Kang DH, Lim TH, Song JK. Aortic valve adaptation to aortic root dilatation: insights into the mechanism of functional aortic regurgitation from 3-dimensional cardiac computed tomography. Circ Cardiovasc Imaging 2014; 7:828-35. [PMID: 25051951 DOI: 10.1161/circimaging.113.001976] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 3-dimensional relationship between aortic root and cusp is essential to understand the mechanism of aortic regurgitation (AR) because of aortic root dilatation (ARD). We sought to test the hypothesis that the stretched cusps in ARD enlarge to compensate for ARD. METHODS AND RESULTS Computed tomography imaged 92 patients (57 with ARD, 29 with moderate to severe AR, 28 without significant AR) and 35 normal controls. Specialized 3-dimensional software measured individual cusp surface areas relative to maximal mid-sinus cross-sectional area and minimal 3-dimensional annular area, coaptation area fraction, and asymmetry of sinus volumes and intercommissural distances. Total open cusp surface area increased (P<0.001) from 7.6±1.4 cm(2)/m(2) in normals to 12.9±2.2 cm(2)/m(2) in AR-negative and 15.2±3.3 cm(2)/m(2) in AR-positive patients. However, the ratio of closed cusp surface area to maximal mid-sinus area, reflecting cusp adaptation, decreased from normals to AR-negative to AR-positive patients (1.38±0.20, 1.15±0.15, 0.88±0.15; P<0.001), creating the lowest coaptation area fraction. Cusp distensibility (closed diastolic versus open area) decreased from 20% in controls and AR-negative patients to 5% in AR-positive patients (P<0.001). Multivariate determinants of AR and coaptation area fraction reflected both sinus size and cusp-to-annular adaptation. ARD was also progressively asymmetrical with root size, and individual cusp surface areas failed to match this asymmetry. CONCLUSIONS Aortic cusp enlargement occurs in ARD, but cusp adaptation and distensibility become limited in prominent, asymmetrical ARD, leading to AR. Optimal AR repair tailored to individual patient anatomy can benefit from appreciating valve adaptation and 3-dimensional relationships; understanding cusp adaptation mechanisms may ultimately provide therapeutic opportunities to improve such compensation.
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Affiliation(s)
- Dae-Hee Kim
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Mark D Handschumacher
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Robert A Levine
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Byung Joo Sun
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Jeong Yoon Jang
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Dong Hyun Yang
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Joon-Won Kang
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Jong-Min Song
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Duk-Hyun Kang
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Tae-Hwan Lim
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.)
| | - Jae-Kwan Song
- From the Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea (D.-H. Kim, B.J.S., J.Y.J., D.H.Y., J.-W.K., J.-M.S., D.-H. Kang, T.-H.L., J.-K.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.D.H., R.A.L.).
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Gordic S, Alkadhi H. [Investigation techniques and importance of CT for diagnostics of cardiac valvular diseases]. Radiologe 2014; 53:864-71. [PMID: 24002182 DOI: 10.1007/s00117-012-2469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE Cardiac computed tomography (CT) is the first-line modality for coronary assessment. In addition valvular morphology and function can be evaluated. STANDARD RADIOLOGICAL METHODS The method of choice for the evaluation of cardiac valves is echocardiography, followed by magnetic resonance imaging. METHODICAL INNOVATIONS Recent technical improvements and advances in temporal resolution allow a detailed anatomical and functional evaluation of the cardiac valves. PERFORMANCE Cardiac CT provides an excellent image quality of the aortic and mitral valve thus enabling an evaluation of the morphology. In addition, cardiac CT allows an assessment of aortic valve function with respect to the grading of stenosis and regurgitation. ACHIEVEMENTS Cardiac CT is not considered the first-line modality for the evaluation of cardiac valves; however, beyond coronary assessment CT provides important information on the morphology and function of cardiac valves. PRACTICAL RECOMMENDATIONS Cardiac CT can be a useful imaging alternative for patients in whom other more commonly used methods, such as echocardiography and magnetic resonance imaging fail to provide the necessary information.
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Affiliation(s)
- S Gordic
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz,
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Mor-Avi V, Patel AR. Aortic annulus measurements: should we use multislice computed tomography, 3D echocardiography or MRI? Expert Rev Cardiovasc Ther 2014; 11:1-3. [DOI: 10.1586/erc.12.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Morganti S, Valentini A, Favalli V, Serio A, Gambarin FI, Vella D, Mazzocchi L, Massetti M, Auricchio F, Arbustini E. Aortic root 3D parametric morphological model from 2D-echo images. Comput Biol Med 2013; 43:2196-204. [DOI: 10.1016/j.compbiomed.2013.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/18/2013] [Accepted: 09/21/2013] [Indexed: 10/26/2022]
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Oshita C, Murata K, Wada Y, Nao T, Uchida K, Okuda S, Susa T, Tanaka N, Matsuzaki M, Yano M. Assessment of the aortic valve annular geometry by real-time three-dimensional transthoracic echocardiography: comparison with two-dimensional transthoracic echocardiography and multidetector computed tomography. J Echocardiogr 2013; 12:24-30. [DOI: 10.1007/s12574-013-0197-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/04/2013] [Accepted: 11/07/2013] [Indexed: 11/29/2022]
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Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 2013; 27:32-41. [PMID: 24238752 DOI: 10.1016/j.echo.2013.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery. METHODS In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n = 57) and bicuspid AS (n = 26) and in patients without AS (n = 32). The energy loss coefficient was also measured in patients with AS. RESULTS In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%). CONCLUSIONS Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.
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Jainandunsing JS, Mahmood F, Matyal R, Shakil O, Hess PE, Lee J, Panzica PJ, Khabbaz KR. Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis. Ann Thorac Surg 2013; 96:1343-1348. [DOI: 10.1016/j.athoracsur.2013.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/03/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
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Kasel AM, Cassese S, Bleiziffer S, Amaki M, Hahn RT, Kastrati A, Sengupta PP. Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. JACC Cardiovasc Imaging 2013; 6:249-62. [PMID: 23489539 DOI: 10.1016/j.jcmg.2012.12.005] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 02/06/2023]
Abstract
The safety and efficacy of transcatheter aortic valve replacement procedures are directly related to proper imaging. This report revisits the existing noninvasive and invasive approaches that have concurrently evolved to meet the demands for optimal selection and guidance of patients undergoing transcatheter aortic valve replacement. The authors summarize the published evidence and discuss the strengths and pitfalls of echocardiographic, computed tomographic, and calibrated aortic balloon valvuloplasty techniques in sizing the aortic valve annulus. Specific proposals for 3-dimensional tomographic reconstructions of complex 3-dimensional aortic root anatomy are provided for reducing intermodality variability in annular sizing. Finally, on the basis of the sizing approaches discussed in this review, the authors provide practical recommendations for balloon-expandable and self-expandable prostheses selection. Strategic use of echocardiographic, multislice computed tomographic, and angiographic data may provide complementary information for determining the anatomical suitability, efficacy, and safety of the procedure.
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Affiliation(s)
- Albert M Kasel
- Clinic for Cardiology and Cardiovascular Diseases, Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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Sfeir PM, Abchee AB, Ghazzal Z, Beresian J, Gellad P, Ayoub CM. Endovascular Transcatheter Aortic Valve Implantation: An Evolving Standard. J Cardiothorac Vasc Anesth 2013; 27:765-78. [DOI: 10.1053/j.jvca.2012.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Indexed: 11/11/2022]
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Bazeed MF, Rezk AI, Moselhy MS. Value of cardiac CT in comprehensive aortic valve and root evaluation before percutaneous aortic valve replacement. Acta Radiol 2013; 54:498-504. [PMID: 23535182 DOI: 10.1177/0284185113477391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most frequent valvular heart disease, and patients who develop AS are at a high risk of sudden death. There is no medical cure available, and aortic valve replacement is the only effective treatment for advanced disease. Preoperative evaluation is the cornerstone of therapy and is necessary for selecting the implantation technique and valve. PURPOSE To evaluate the role of cardiac CT in comprehensive aortic valve and aortic root evaluation before percutaneous aortic valve replacement. MATERIAL AND METHODS Thirty-four patients with severe aortic valve stenosis were evaluated by cardiac CT. The aortic valve calcification grade defined by cardiac CT was compared to the operative findings. The mean calculated aortic annulus diameter (CAAD) measured by cardiac CT was compared to the aortic annulus diameter measured by transthoracic echocardiography (TTE) as well as during the operation. The distances from the aortic valve annulus to the coronary ostia (right and left) were measured by cardiac CT and compared to the intraoperative measurements. The findings from the CT coronary angiography and conventional coronary angiography were compared. RESULTS There was strong agreement (k = 0.865) between the calcification grade by cardiac CT and the intraoperative grading. There was a stronger correlation (r = 0.948) between the CAAD assessed by cardiac CT and intraoperatively compared to the correlation between the intraoperative versus TTE measurements (r = 0.660). The distances measured between the aortic annulus and the right and left coronary artery ostia by cardiac CT were strongly correlated with the distances measured intraoperatively (r = 0.966 and 0.940 in the right and left sides, respectively). Cardiac CT detected three coronary artery stenotic lesions and three patent stents. All findings were confirmed by conventional coronary angiography. Thirteen percent of the evaluated coronary artery segments were of non-diagnostic quality by cardiac CT. CONCLUSION Cardiac CT substantially facilitates the assessment of aortic root morphology prior to aortic valve replacement.
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Affiliation(s)
| | - Ahmad Ibrahim Rezk
- Department of Cardiac Surgery, Faculty of Medicine, Aim Shams University
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Chenier M, Tuzcu EM, Kapadia SR, Krishnaswamy A. Multimodality imaging in the cardiac catheterization laboratory: a new era in sight. Interv Cardiol 2013. [DOI: 10.2217/ica.13.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nasis A, Mottram PM, Cameron JD, Seneviratne SK. Current and Evolving Clinical Applications of Multidetector Cardiac CT in Assessment of Structural Heart Disease. Radiology 2013; 267:11-25. [DOI: 10.1148/radiol.13111196] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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To ACY, Schoenhagen P, Desai MY. Role of tomographic imaging in preoperative planning and postoperative assessment in cardiovascular surgery. Heart 2013; 99:1048-60. [DOI: 10.1136/heartjnl-2012-301751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bateman MG, Hill AJ, Quill JL, Iaizzo PA. The clinical anatomy and pathology of the human arterial valves: implications for repair or replacement. J Cardiovasc Transl Res 2013; 6:166-75. [PMID: 23325456 DOI: 10.1007/s12265-012-9438-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023]
Abstract
A thorough understanding of valvar anatomy is essential for design engineers and clinicians in the development and/or employment of improved technologies or therapies for treating valvar pathologies. There are two arterial valves in the human heart--pulmonary and aortic valves. Both are complex structures whose normal anatomical components can vary greatly between individuals. We discuss the anatomy, pathology, and challenges relating to transcatheter and surgical repair/replacement of the arterial valves in a translational manner. The high prevalence of aortic valvar pathologies in the burgeoning elderly population, coupled with poor clinical outcomes for patients who go untreated, has resulted in prolific spending in the research and development of more effective and less traumatic therapies. The accelerated development of therapies for treating arterial valves has been guided by anatomical information gathered from high-resolution imaging technologies, which have focused attention on the need for complete understanding of arterial valvar clinical anatomies. This article is part of a JCTR special issue on Cardiac Anatomy.
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg 2012; 144:e29-84. [PMID: 22898522 DOI: 10.1016/j.jtcvs.2012.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Snow TM, Moat N, Barker S, Duncan A, Di Mario C. Transcatheter aortic valve implantation. Glob Cardiol Sci Pract 2012; 2012:12. [PMID: 25610843 PMCID: PMC4239814 DOI: 10.5339/gcsp.2012.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/17/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas M Snow
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Neil Moat
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sarah Barker
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Alison Duncan
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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Abstract
The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.
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Affiliation(s)
- W S Choo
- Penang Medical College, Georgetown, Malaysia
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37
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Haj-Ali R, Marom G, Ben Zekry S, Rosenfeld M, Raanani E. A general three-dimensional parametric geometry of the native aortic valve and root for biomechanical modeling. J Biomech 2012; 45:2392-7. [PMID: 22854206 DOI: 10.1016/j.jbiomech.2012.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/12/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
The complex three-dimensional (3D) geometry of the native tricuspid aortic valve (AV) is represented by select parametric curves allowing for a general construction and representation of the 3D-AV structure including the cusps, commissures and sinuses. The proposed general mathematical description is performed by using three independent parametric curves, two for the cusp and one for the sinuses. These curves are used to generate different surfaces that form the structure of the AV. Additional dependent curves are also generated and utilized in this process, such as the joint curve between the cusps and the sinuses. The model's feasibility to generate patient-specific parametric geometry is examined against 3D-transesophageal echocardiogram (3D-TEE) measurements from a non-pathological AV. Computational finite-element (FE) mesh can then be easily constructed from these surfaces. Examples are given for constructing several 3D-AV geometries by estimating the needed parameters from echocardiographic measurements. The average distance (error) between the calculated geometry and the 3D-TEE measurements was only 0.78±0.63mm. The proposed general 3D parametric method is very effective in quantitatively representing a wide range of native AV structures, with and without pathology. It can also facilitate a methodical quantitative investigation over the effect of pathology and mechanical loading on these major AV parameters.
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Affiliation(s)
- Rami Haj-Ali
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
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Cardiac CT in Valvular Heart Disease: Current State-of-the-Art. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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Comparison of aortic root measurements in patients undergoing transapical aortic valve implantation (TA-AVI) using three-dimensional rotational angiography (3D-RA) and multislice computed tomography (MSCT): differences and variability. Int J Cardiovasc Imaging 2012; 29:417-24. [PMID: 22710987 DOI: 10.1007/s10554-012-0081-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
To evaluate for the first time the degree of compliance between conventional multislice computed tomography (MSCT) and three-dimensional rotational angiography (3D-RA) in measuring relevant dimensions of the aortic annulus, the aortic root and the thoracic aorta in patients undergoing TA-AVI. Twenty-seven patients (82 ± 11 years) with severe aortic stenosis received contrast enhanced ECG gated MSCT prior to TA-AVI and intra-procedural rotational angiography. The aortic annulus size, the distance to the coronary ostia and diameters of the aortic root and the thoracic aorta were measured with both methods by two observers blinded to each other. Linear regression and Bland-Altman analysis were performed to determine the degree of compliance between both methods. The limits of agreement were within two standard deviations for all measurements and with high correlation especially for the supra-annular dimensions. Sizing of the aortic annulus revealed lower interobserver variability for MSCT than for 3D-RA with a maximum deviation of 2.1 ± 2.5 and 1.7 ± 2.8 mm for diameter measurements and for the effective diameter, respectively. With current protocols intra-procedural 3D-RA provides good image quality especially for structures above the aortic annulus. Due to a lower interobserver variability in sizing the aortic annulus MSCT remains more suitable for aortic root assessment prior to TA-AVI.
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Bazeed MF, Moselhy MS, Rezk AI, Al-Murayeh MA. Low radiation dose non-contrast cardiac CT: is it of value in the evaluation of mechanical aortic valve. Acta Radiol 2012; 53:389-93. [PMID: 22422269 DOI: 10.1258/ar.2012.110253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prosthetic bileaflet mechanical valve function has been traditionally evaluated using echocardiography and fluoroscopy. Multidetector computed tomography (MDCT) is a novel technique for cardiac evaluation. PURPOSE To evaluate bileaflet mechanical aortic valves using a low-milliampere (mA), non-contrast MDCT protocol with a limited scan range. MATERIAL AND METHODS Forty patients with a bileaflet mechanical aortic valve were evaluated using a non-contrast, low-mA, ECG-gated 64 MDCT protocol with a limited scan range. MDCT findings of opening and closing valve angles were correlated to fluoroscopy and echocardiography. Also, the valve visibility was evaluated on MDCT and fluoroscopy according to a 3-point grading scale. RESULTS The visualization score with the MDCT was significantly superior to the fluoroscopy (3 vs. 2.7). A strong correlation was noted between the opening (r = 0.82) and closing (r = 0.96) valve angles with MDCT and fluoroscopy without a statistically significant difference (P = 0.31 and 0.16, respectively). The mean effective radiation dose of the suggested protocol was 4 ± 0.5 mSv. Five valves were evaluated using transesophageal echocardiography because the valves were difficult to evaluate with transthoracic echocardiography, and all of these valves were evaluated optimally with MDCT. A high-pressure gradient was noted in nine valves, and the MDCT showed that seven of these valves inadequately opened, and two valves opened well, which resulted in patient valve mismatch. Incomplete valve closure was noted in five valves, and the echocardiography showed significant transvalvular regurgitation in all five valves. CONCLUSION MDCT can provide a precise measurement of valve function and can potentially evaluate high-pressure gradients and transvalvular regurgitation.
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Affiliation(s)
- Mohamed Fayez Bazeed
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
| | | | - Ahmad Ibrahim Rezk
- Department of Cardiac Surgery, Faculty of Medicine, Aim Shams University, Egypt
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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42
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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Krishnaswamy A, Tuzcu EM, Kapadia SR. Use of intraprocedural CT imaging to guide alcohol septal ablation of hypertrophic cardiomyopathy in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2012; 80:991-4. [DOI: 10.1002/ccd.23418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/07/2011] [Indexed: 11/09/2022]
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44
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 544] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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45
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La Manna A, Sanfilippo A, Capodanno D, Salemi A, Polizzi G, Deste W, Cincotta G, Cadoni A, Marchese A, Figuera M, Ussia GP, Pittalà R, Privitera C, Tamburino C. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson 2011; 13:82. [PMID: 22202669 PMCID: PMC3271968 DOI: 10.1186/1532-429x-13-82] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 12/27/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Before trans-catheter aortic valve implantation (TAVI), assessment of cardiac function and accurate measurement of the aortic root are key to determine the correct size and type of the prosthesis. The aim of this study was to compare cardiovascular magnetic resonance (CMR) and trans-thoracic echocardiography (TTE) for the assessment of aortic valve measurements and left ventricular function in high-risk elderly patients submitted to TAVI. METHODS Consecutive patients with severe aortic stenosis and contraindications for surgical aortic valve replacement were screened from April 2009 to January 2011 and imaged with TTE and CMR. RESULTS Patients who underwent both TTE and CMR (n = 49) had a mean age of 80.8 ± 4.8 years and a mean logistic EuroSCORE of 14.9 ± 9.3%. There was a good correlation between TTE and CMR in terms of annulus size (R2 = 0.48, p < 0.001), left ventricular outflow tract (LVOT) diameter (R2 = 0.62, p < 0.001) and left ventricular ejection fraction (LVEF) (R2 = 0.47, p < 0.001) and a moderate correlation in terms of aortic valve area (AVA) (R2 = 0.24, p < 0.001). CMR generally tended to report larger values than TTE for all measurements. The Bland-Altman test indicated that the 95% limits of agreement between TTE and CMR ranged from -5.6 mm to + 1.0 mm for annulus size, from -0.45 mm to + 0.25 mm for LVOT, from -0.45 mm2 to + 0.25 mm2 for AVA and from -29.2% to 13.2% for LVEF. CONCLUSIONS In elderly patients candidates to TAVI, CMR represents a viable complement to transthoracic echocardiography.
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Affiliation(s)
- Alessio La Manna
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Alessandra Sanfilippo
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
- Excellence Through Newest Advances (ETNA) Foundation, (Viale XX Settembre 70), Catania, (95129), Italy
| | - Antonella Salemi
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Gesualdo Polizzi
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Wanda Deste
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Glauco Cincotta
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Alessandra Cadoni
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Anna Marchese
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Michele Figuera
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Gian P Ussia
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
| | - Rosetta Pittalà
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Carmelo Privitera
- Radiology Unit, Vittorio Emanuele Hospital, (via Plebiscito 628), Catania, (95122), Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, (via Citelli 1), Catania, (95100), Italy
- Excellence Through Newest Advances (ETNA) Foundation, (Viale XX Settembre 70), Catania, (95129), Italy
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Bharucha T, Fernandes F, Slorach C, Mertens L, Friedberg MK. Measurement of Effective Aortic Valve Area Using Three-Dimensional Echocardiography in Children Undergoing Aortic Balloon Valvuloplasty for Aortic Stenosis. Echocardiography 2011; 29:484-91. [DOI: 10.1111/j.1540-8175.2011.01595.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pires de Morais G, Bettencourt N, Silva G, Ferreira N, Sousa O, Caeiro D, Rocha J, Carvalho M, Leite D, Braga P, Fonseca C, Gama V. [Multislice computed tomography in the selection of candidates for transcatheter aortic valve implantation]. Rev Port Cardiol 2011; 30:717-26. [PMID: 21958996 DOI: 10.1016/s0870-2551(11)70015-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/24/2011] [Indexed: 10/16/2022] Open
Abstract
Transcatheter aortic valve implantation is an emerging treatment option for severe symptomatic aortic stenosis in patients considered unsuitable for surgical valve replacement. The authors review the use of multislice computed tomography in the selection of candidates for transcatheter aortic valve replacement, procedural support and post-interventional follow-up. A single-center experience of the role of this imaging technique is also described. Multislice computed tomography is an essential imaging tool in the selection and exclusion of candidates for transcatheter aortic valve implantation, providing evaluation of coronary anatomy and the relationship of the coronary ostia with the aortic valve structure, and accurate analysis of the valve annulus and aortic root, left ventricular outflow tract, aorta and peripheral vascular access routes. Multislice computed tomography is also central to the choice of appropriate prosthesis size. In addition, it guides arterial puncture by image fusion techniques and enables correct prosthesis apposition to be verified. This review aims to describe the role of computed tomography in this increasingly common interventional valve procedure, providing an overview of current knowledge and applications.
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Affiliation(s)
- Gustavo Pires de Morais
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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O'Brien B, Schoenhagen P, Kapadia SR, Svensson LG, Rodriguez L, Griffin BP, Tuzcu EM, Desai MY. Integration of 3D Imaging Data in the Assessment of Aortic Stenosis. Circ Cardiovasc Imaging 2011; 4:566-73. [DOI: 10.1161/circimaging.111.964916] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bridget O'Brien
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Paul Schoenhagen
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Samir R. Kapadia
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Lars G. Svensson
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Leonardo Rodriguez
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Brian P. Griffin
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - E. Murat Tuzcu
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
| | - Milind Y. Desai
- From the Heart and Vascular Institute (B.O., P.S., S.R.K., L.G.S., L.R., B.P.G., E.M.T., M.Y.D.) and Imaging Institute (P.S., L.R., M.Y.D.), the Cleveland Clinic, Cleveland, OH
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49
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Multislice computed tomography in the selection of candidates for transcatheter aortic valve implantation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2174-2049(11)70015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Qanadli SD. Cardiac CT: practical approach to integrate appropriate indications in daily practice. Presse Med 2011; 40:e413-23. [PMID: 21733657 DOI: 10.1016/j.lpm.2011.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 05/16/2011] [Indexed: 11/16/2022] Open
Abstract
Recent advances in CT technologies had significantly improved the clinical utility of cardiac CT. Major efforts have been made to optimize the image quality, standardize protocols and limit the radiation exposure. Rapid progress in post-processing tools dedicated not only to the coronary artery assessment but also to the cardiac cavities, valves and veins extended applications of cardiac CT. This potential might be however used optimally considering the current appropriate indications for use as well as the current technical imitations. Coronary artery disease and related ischemic cardiomyopathy remain the major applications of cardiac CT and at the same time the most complex one. Integration of a specific knowledge is mandatory for optimal use in this area for asymptomatic as for symptomatic patients, with a specific regards to patient with acute chest pain. This review aimed to propose a practical approach to implement appropriate indications in our routine practice. Emerging indications and future direction are also discussed. Adequate preparation of the patient, training of physicians, and the multidisciplinary interaction between actors are the key of successful implementation of cardiac CT in daily practice.
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Affiliation(s)
- Salah D Qanadli
- Cardiothoracic and Vascular Unit, Department of radiology, CHUV-University of Lausanne, Lausanne, Switzerland.
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