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González-García A, Pazos-López P, Calvo-Iglesias FE, Matajira-Chía TM, Bilbao-Quesada R, Blanco-González E, González-Ríos C, Castiñeira-Busto M, Barreiro-Pérez M, Íñiguez-Romo A. Diagnostic Challenges in Aortic Stenosis. J Cardiovasc Dev Dis 2024; 11:162. [PMID: 38921662 PMCID: PMC11203729 DOI: 10.3390/jcdd11060162] [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: 03/30/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients.
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Affiliation(s)
- André González-García
- Department of Cardiology, Hospital Alvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, 36312 Vigo, Spain; (F.E.C.-I.); (T.M.M.-C.); (R.B.-Q.); (E.B.-G.); (C.G.-R.); (M.C.-B.); (M.B.-P.); (A.Í.-R.)
| | - Pablo Pazos-López
- Department of Cardiology, Hospital Alvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, 36312 Vigo, Spain; (F.E.C.-I.); (T.M.M.-C.); (R.B.-Q.); (E.B.-G.); (C.G.-R.); (M.C.-B.); (M.B.-P.); (A.Í.-R.)
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2
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Racz AO, Szabo GT, Papp T, Csippa B, Gyurki D, Kracsko B, Koszegi Z, Kolozsvari R. Potential Clinical Usefulness of Post-Valvular Contrast Densities to Determine the Severity of Aortic Valve Stenosis Using Computed Tomography. J Cardiovasc Dev Dis 2023; 10:412. [PMID: 37887859 PMCID: PMC10607528 DOI: 10.3390/jcdd10100412] [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: 07/30/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Different methods are established for the changes in aortic valve stenosis with cardiac computed tomography angiography (CCTA), but the effect of the grade of stenosis on contrast densities around the valve has not been investigated. AIMS/METHODS Using the information from flow dynamics in cases of increased velocity through narrowed lumen, the hypothesis was formed that flow changes can alter the contrast densities in stenotic post-valvular regions, and the density changes might correlate with the grade of stenosis. Forty patients with severe aortic stenosis and fifteen with a normal aortic valve were enrolled. With echocardiography, the peak/mean transvalvular gradients, peak transvalvular velocity, and aortic valve opening area were obtained. With CCTA, densities 4-5 mm above the aortic valve; at the junction of the left, right, and noncoronary cusp to the annulus; at the middle level of the left, right, and noncoronary sinuses of Valsalva in the center and the lateral points; at the sinotubular junction; and 4 cm from the sinotubular junction at the midline were measured. First, a comparison of the densities between the normal and stenotic valve was performed, and then possible correlations between echocardiography and CCTA values were investigated in the stenotic group. RESULTS In all CCTA regions, significantly lower-density values were detected among stenotic valve patients compared to the normal aortic valve population. Additionally, in both groups, higher densities were measured in the peri-jet regions than in the lateral ones. Furthermore, a good correlation was found between the aortic valve opening area and the densities in almost all perivalvular areas. With regard to the densities at the junction of the non-coronary leaflet to the fibrotic annulus and at the most lateral point of the right sinus of Valsalva, a high level of correlation was found between all echocardiography and CCTA parameters. Lastly, with receiver operating characteristic curve measurements, area under the curve values were between 0.857 and 0.930. CONCLUSION Certain CCTA density values, especially 4-5mm above the valve opening, can serve as auxiliary information to echocardiography when the severity of aortic valve stenosis is unclear.
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Affiliation(s)
- Agnes Orsolya Racz
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Gabor Tamas Szabo
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Tamas Papp
- Department of Radiology, University of Debrecen, 4032 Debrecen, Hungary;
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (D.G.)
| | - Daniel Gyurki
- Department of Hydrodynamic Systems, University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (D.G.)
| | - Bertalan Kracsko
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
| | - Zsolt Koszegi
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
- 3rd Department of Internal Medicine, Szabolcs-Szatmar-Bereg County Hospital, 4400 Nyíregyháza, Hungary
| | - Rudolf Kolozsvari
- Department of Cardiology and Heart Surgery, University of Debrecen, 4032 Debrecen, Hungary; (A.O.R.); (G.T.S.); (B.K.); (Z.K.)
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3
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Does clinical data quality affect fluid-structure interaction simulations of patient-specific stenotic aortic valve models? J Biomech 2019; 94:202-210. [DOI: 10.1016/j.jbiomech.2019.07.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022]
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Estimation of valvular resistance of segmented aortic valves using computational fluid dynamics. J Biomech 2019; 94:49-58. [DOI: 10.1016/j.jbiomech.2019.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022]
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Elattar MA, Kaya A, Planken NR, Baan J, Vanbavel ET, de Mol BAJM, Marquering HA. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27:505-511. [PMID: 29659843 DOI: 10.1093/icvts/ivy128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive aortic valve replacement has proven its value over the last decade by its significant advancement and reduction in mortality, morbidity and admission time. However, minimally invasive aortic valve replacement is associated with some on-site difficulties such as limited aortic annulus exposure. Currently, computed tomography scans are used to evaluate the anatomical relationship among the intercostal spaces, ascending aorta and aortic valve prior to surgery. We hypothesized that quantitative measurements of access distance and access angle are associated with outcome and access difficulty. METHODS We introduce a novel minimally invasive aortic valve replacement planning prototype that allows automatic measurements of access angle, access distance and aortic annulus dimensions. The prototype visualizes these measurements on the chest cage as ISO contours. The association of these measures with outcome parameters such as extracorporeal circulation time, aortic cross-clamping time and access difficulty score was assessed. We included 14 patients who received a new valve by ministernotomy. RESULTS The mean access angle was 40.3 ± 5.1°. It was strongly associated with aortic cross-clamping time (Pearson correlation coefficient = 0.60, P = 0.02) and access difficulty score (Spearman's rank correlation coefficient = 0.57, P = 0.03). Access angles were significantly different between easy and difficult access groups (P = 0.03). There was no significant association between access distance and outcome parameters. CONCLUSIONS Access angle is strongly associated with procedure complexity. The automated presentation of this measure suggests added value of the prototype in clinical practice.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Informatics Science, Communication and Information Technology School, Nile University, Giza, Egypt
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nils R Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ed T Vanbavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Khalil A, Ng SC, Liew YM, Lai KW. An Overview on Image Registration Techniques for Cardiac Diagnosis and Treatment. Cardiol Res Pract 2018; 2018:1437125. [PMID: 30159169 PMCID: PMC6109558 DOI: 10.1155/2018/1437125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/05/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Image registration has been used for a wide variety of tasks within cardiovascular imaging. This study aims to provide an overview of the existing image registration methods to assist researchers and impart valuable resource for studying the existing methods or developing new methods and evaluation strategies for cardiac image registration. For the cardiac diagnosis and treatment strategy, image registration and fusion can provide complementary information to the physician by using the integrated image from these two modalities. This review also contains a description of various imaging techniques to provide an appreciation of the problems associated with implementing image registration, particularly for cardiac pathology intervention and treatments.
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Affiliation(s)
- Azira Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Faculty of Science and Technology, Islamic Science University of Malaysia, 71800 Nilai, Negeri Sembilan, Malaysia
| | - Siew-Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Khalil A, Faisal A, Lai KW, Ng SC, Liew YM. 2D to 3D fusion of echocardiography and cardiac CT for TAVR and TAVI image guidance. Med Biol Eng Comput 2016; 55:1317-1326. [PMID: 27830464 DOI: 10.1007/s11517-016-1594-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
This study proposed a registration framework to fuse 2D echocardiography images of the aortic valve with preoperative cardiac CT volume. The registration facilitates the fusion of CT and echocardiography to aid the diagnosis of aortic valve diseases and provide surgical guidance during transcatheter aortic valve replacement and implantation. The image registration framework consists of two major steps: temporal synchronization and spatial registration. Temporal synchronization allows time stamping of echocardiography time series data to identify frames that are at similar cardiac phase as the CT volume. Spatial registration is an intensity-based normalized mutual information method applied with pattern search optimization algorithm to produce an interpolated cardiac CT image that matches the echocardiography image. Our proposed registration method has been applied on the short-axis "Mercedes Benz" sign view of the aortic valve and long-axis parasternal view of echocardiography images from ten patients. The accuracy of our fully automated registration method was 0.81 ± 0.08 and 1.30 ± 0.13 mm in terms of Dice coefficient and Hausdorff distance for short-axis aortic valve view registration, whereas for long-axis parasternal view registration it was 0.79 ± 0.02 and 1.19 ± 0.11 mm, respectively. This accuracy is comparable to gold standard manual registration by expert. There was no significant difference in aortic annulus diameter measurement between the automatically and manually registered CT images. Without the use of optical tracking, we have shown the applicability of this technique for effective fusion of echocardiography with preoperative CT volume to potentially facilitate catheter-based surgery.
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Affiliation(s)
- Azira Khalil
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Amir Faisal
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siew Cheok Ng
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Al-Najafi S, Sanchez F, Lerakis S. The Crucial Role of Cardiac Imaging in Transcatheter Aortic Valve Replacement (TAVR): Pre- and Post-procedural Assessment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:70. [DOI: 10.1007/s11936-016-0497-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Elattar M, Wiegerinck E, van Kesteren F, Dubois L, Planken N, Vanbavel E, Baan J, Marquering H. Automatic aortic root landmark detection in CTA images for preprocedural planning of transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2015; 32:501-11. [PMID: 26498339 PMCID: PMC4751164 DOI: 10.1007/s10554-015-0793-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve implantation is currently a well-established minimal invasive treatment option for patients with severe aortic valve stenosis. CT Angiography is used for the pre-operative planning and sizing of the prosthesis. To reduce the inconsistency in sizing due to interobserver variability, we introduce and evaluate an automatic aortic root landmarks detection method to determine the sizing parameters. The proposed algorithm detects the sinotubular junction, two coronary ostia, and three valvular hinge points on a segmented aortic root surface. Using these aortic root landmarks, the automated method determines annulus radius, annulus orientation, and distance from annulus plane to right and left coronary ostia. Validation is performed by the comparison with manual measurements of two observers for 40 CTA image datasets. Detection of landmarks showed high accuracy where the mean distance between the automatically detected and reference landmarks was 2.81 ± 2.08 mm, comparable to the interobserver variation of 2.67 ± 2.52 mm. The mean annulus to coronary ostium distance was 16.9 ± 3.3 and 17.1 ± 3.3 mm for the automated and the reference manual measurements, respectively, with a mean paired difference of 1.89 ± 1.71 mm and interobserver mean paired difference of 1.38 ± 1.52 mm. Automated detection of aortic root landmarks enables automated sizing with good agreement with manual measurements, which suggests applicability of the presented method in current clinical practice.
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Affiliation(s)
- Mustafa Elattar
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Esther Wiegerinck
- Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Floortje van Kesteren
- Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucile Dubois
- Biomedical Engineering, Polytech Lyon, Université Claude Bernard Lyon, Villeurbanne, France
| | - Nils Planken
- Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ed Vanbavel
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk Marquering
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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10
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Lerman DA, Prasad S, Alotti N. Calcific Aortic Valve Disease: Molecular Mechanisms and Therapeutic Approaches. Eur Cardiol 2015; 10:108-112. [PMID: 27274771 PMCID: PMC4888946 DOI: 10.15420/ecr.2015.10.2.108] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/28/2015] [Indexed: 01/28/2023] Open
Abstract
Calcification occurs in atherosclerotic vascular lesions and In the aortic valve. Calcific aortic valve disease (CAVD) is a slow, progressive disorder that ranges from mild valve thickening without obstruction of blood flow, termed aortic sclerosis, to severe calcification with impaired leaflet motion, termed aortic stenosis. In the past, this process was thought to be 'degenerative' because of time-dependent wear and tear of the leaflets, with passive calcium deposition. The presence of osteoblasts in atherosclerotic vascular lesions and in CAVD implies that calcification is an active, regulated process akin to atherosclerosis, with lipoprotein deposition and chronic inflammation. If calcification is active, via pro-osteogenic pathways, one might expect that development and progression of calcification could be inhibited. The overlap in the clinical factors associated with calcific valve disease and atherosclerosis provides further support for a shared disease mechanism. In our recent research we used an in vitro porcine valve interstitial cell model to study spontaneous calcification and potential promoters and inhibitors. Using this model, we found that denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor-κB ligand may, at a working concentration of 50 μg/mL, inhibit induced calcium deposition to basal levels.
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Affiliation(s)
- Daniel Alejandro Lerman
- Royal Infirmary Hospital of Edinburgh (NHS Lothian), The University of Edinburgh, United Kingdom
| | - Sai Prasad
- Royal Infirmary Hospital of Edinburgh (NHS Lothian), The University of Edinburgh, United Kingdom
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11
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Evaluation of the aortic and mitral valves with cardiac computed tomography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2012; 28 Suppl 2:109-27. [PMID: 23139149 DOI: 10.1007/s10554-012-0144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
Cardiac computed tomography (CT) produces high-quality anatomical images of the cardiac valves and associated structures. Cardiac magnetic resonance imaging (MRI) provides images of valve morphology, and allows quantitative evaluation of valvular dysfunction and determination of the impact of valvular lesions on cardiovascular structures. Recent studies have demonstrated that cardiac CT and MRI are important adjuncts to echocardiography for the evaluation of aortic and mitral valvular heart diseases (VHDs). Radiologists should be aware of the technical aspects of cardiac CT and MRI that allow comprehensive assessment of aortic and mitral VHDs, as well as the typical imaging features of common and important aortic and mitral VHDs on cardiac CT and MRI.
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12
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Buttan AK, Yang EH, Budoff MJ, Vorobiof G. Evaluation of valvular disease by cardiac computed tomography assessment. J Cardiovasc Comput Tomogr 2012; 6:381-92. [DOI: 10.1016/j.jcct.2012.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 12/31/2022]
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13
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Kakouros N, Giles J, Crundwell N, McWilliams E. The utility of cardiac CT beyond the assessment of suspected coronary artery disease. Clin Radiol 2012; 67:695-708. [DOI: 10.1016/j.crad.2011.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 11/19/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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14
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Lee SC, Ko SM, Song MG, Shin JK, Chee HK, Hwang HK. Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings. Int J Cardiovasc Imaging 2012; 28 Suppl 1:33-44. [PMID: 22592485 DOI: 10.1007/s10554-012-0066-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/04/2012] [Indexed: 12/19/2022]
Abstract
To compare the diagnostic accuracies of coronary computed tomography angiography (CCTA), cardiovascular magnetic resonance (CMR), and transthoracic echocardiography (TTE) in aortic valve (AV) morphological assessments with operative findings. We retrospectively enrolled 262 patients who underwent CCTA, CMR, and TTE before AV surgery. Two independent blinded observers assessed AV morphology as being tricuspid, bicuspid, or quadricuspid using three imaging modalities. Interobserver and intermodality agreements were obtained with kappa statistics. The diagnostic accuracies of CCTA, CMR, and TTE for identifying AV morphology (tricuspid vs. non-tricuspid) were compared with intraoperative findings as the reference standard. At surgery, tricuspid AV, bicuspid AV, and quadricuspid AV were present in 179, 80, and 3 patients, respectively. The CCTA and CMR image qualities were all diagnostic. Thirteen cases of TTE were not evaluable due to severe AV calcification. An excellent correlation between CMR and CCTA was seen for the identification of AV morphology (κ = 0.97). Good correlations existed between CCTA and TTE (κ = 0.72) and between CMR and TTE (κ = 0.74). CCTA, CMR, and TTE had an excellent or good interobserver agreement (κ = 0.90, 0.95, and 0.72, respectively). Sensitivity, specificity, and positive and negative predictive values for AV morphology assessment (tricuspid vs. non-tricuspid) were: 97, 95, 98, and 94 % with CCTA (n = 262); 98, 96, 98, and 95 % with CMR (n = 262); and 98, 88, 95, and 96 % with TTE (n = 249). CCTA and CMR are highly accurate for identifying AV morphology.
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Affiliation(s)
- Seung Choul Lee
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea
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Chrysohoou C, Tsiachris D, Stefanadis C. Aortic stenosis in the elderly: challenges in diagnosis and therapy. Maturitas 2011; 70:349-53. [PMID: 22018632 DOI: 10.1016/j.maturitas.2011.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 09/24/2011] [Indexed: 12/16/2022]
Abstract
Severe aortic valve stenosis, remains the main cause of morbidity and mortality in the elderly, reaching a prevalence of 2-7% above the age of 65 years old. Despite its frequency and the development in invasive and noninvasive approach of the disease, several of its aspects remain controversial. This review is focused on the clinical aspects, the indices for assessment severity, newly markers related to prognosis and new therapeutic modalities for the elderly population. The term low flow, low gradient severe aortic stenosis with preserved LV systolic function has revealed a new modality in the field of diagnostic evaluation and therapeutic approach. Aortic valve replacement is the choice therapy for symptomatic severe aortic stenosis. Despite the recent advances in cardiac surgery, the overall operative mortality rate for isolated aortic valve replacement surgery ranges from 2.5% to 4.0% and is higher in octogenarians and can be up to 25% in patients with comorbid conditions. The fact that surgery is not being performed for 30% or more of patients requiring it, a great attention was attracted to the percutaneous transcatheter implantation of a stent-mounted aortic valve. The up to now experience of transcatheter valve implantation in more than 25,000 patients, has shown promising results in terms of mortality and quality of life. Echocardiography still plays the central role for the evaluation of the elderly patient, as it can illustrate the pathophysiological alterations during the course of aortic valve stenosis, and guide appropriate therapy.
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16
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Joo I, Park EA, Kim KH, Lee W, Chung JW, Park JH. MDCT differentiation between bicuspid and tricuspid aortic valves in patients with aortic valvular disease: correlation with surgical findings. Int J Cardiovasc Imaging 2011; 28:171-82. [PMID: 21222037 DOI: 10.1007/s10554-010-9780-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 12/20/2010] [Indexed: 02/01/2023]
Abstract
To identify multi-detector computed tomographic (MDCT) features discriminating bicuspid aortic valves (BAVs) from tricuspid aortic valves (TAVs) in patients with aortic valvular disease using surgical findings as reference. Forty-five patients underwent ECG-gated cardiac MDCT scans prior to aortic valve replacement. Morphologic patterns of aortic valves on MDCT were classified into: bicuspid without raphe (A), fused valve with a fish-mouth opening (B), fused valve without a fish-mouth opening (C), and tricuspid without fusion (D). To differentiate congenital raphe of BAV from commissural fusion of TAV, MDCT features of patterns B and C were evaluated. Diameters of the aortic root and ascending aorta between patients with BAVs and TAVs were also compared. Patterns A (n = 6) and B (n = 6) were all bicuspid, in pattern C: 8 of 26 (30.8%) were bicuspid, and pattern D (n = 7) were all tricuspid. In patterns B and C, uneven cusp size, round-shaped opening and midline calcification at leaflet fusion were strongly associated with BAVs (all, P < 0.05). The mean length of leaflet fusion in BAVs was significantly larger than in TAVs (13.5 vs. 8.7 mm, P < 0.0001), with a cutoff value of 10.3 mm providing a sensitivity of 85.7%, a specificity of 83.3%, and an area under the ROC curve of 0.90. In all patients, the mean diameter of the ascending aorta was larger in patients with BAVs than with TAVs (43.3 vs. 39.7 mm, P < 0.05). MDCT features of uneven cusp size, round-shaped opening, midline calcification, longer leaflet fusion and larger diameter of the ascending aorta can be helpful in distinguishing BAVs from TAVs.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, Daehangno, Jongno-gu, Seoul, 110-744, Korea
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Ketelsen D, Fishman EK, Claussen CD, Vogel-Claussen J. Computed tomography evaluation of cardiac valves: a review. Radiol Clin North Am 2010; 48:783-97. [PMID: 20705173 DOI: 10.1016/j.rcl.2010.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Electrocardiograph (ECG)-gated cardiac computed tomography (CT) angiography has great potential for the evaluation of the cardiac valves, with excellent image quality. The evidence-based, established clinical role of ECG-gated CT coronary angiography provides additional valuable information about valve morphology and function. A wide range of valve pathology, including congenital and acquired conditions, infectious endocarditis, and complications of valve replacement, can be assessed by cardiac CT imaging. Despite recent advances in CT technology, echocardiography remains the gold standard for noninvasive cardiac valve evaluation. Nevertheless, important clinical information about the valves can be obtained with coronary CT angiography examinations. Thus cardiac valve morphology and function should be routinely assessed and reported on coronary CT angiography examinations.
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Affiliation(s)
- Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Germany
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Durst R, Bogot N, Gilon D, Drenger B. Potential role for coronary computerized angiography for assessing preoperative ischemic risk. J Cardiothorac Vasc Anesth 2010; 24:348-55. [PMID: 20149691 DOI: 10.1053/j.jvca.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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