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El-Nashar H, Sabry M, Tseng YT, Francis N, Latif N, Parker KH, Moore JE, Yacoub MH. Multiscale structure and function of the aortic valve apparatus. Physiol Rev 2024; 104:1487-1532. [PMID: 37732828 DOI: 10.1152/physrev.00038.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
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Affiliation(s)
- Hussam El-Nashar
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Malak Sabry
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nadine Francis
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Li Z, Muench G, Wenhart C, Goebel S, Reimann A. Definition of a sectioning plane and place for a section containing hoped-for regions using a spare counterpart specimen. Sci Rep 2022; 12:13342. [PMID: 35922656 PMCID: PMC9349253 DOI: 10.1038/s41598-022-17380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Histological examination of targets in regions of interest in histological sections is one of the most frequently used tools in biomedical research. However, it is a technical challenge to secure a multitarget section for inspection of the structure’s mutual relationship of targets or a longitudinally filamentous- or tubular-formed tissue section for visitation of the overall morphological features. We present a method with a specified cutting plane and place, allowing researchers to cut directly at the multitarget centers accurately and quickly. The method is proven to be reliable with high accuracy and reproducibility and a low coefficient of variation, testing on repeat experiments of three target’s position-known models. With this method, we successfully yielded single sections containing whole intraorbital optical nerves, three aortic valves, or whole thoracic tracheas in their central positions. The adjoined custom-made tools used in the study, such as various tissue-specific formulated calibrated trimming and embedding guides, an organ-shaped cavity plaster mold, and a two-time embedding technique for optimal and identical trimming or embedding, also bear great potential to become a common supplemental tool for traditional histology and may contribute to the reduction of the labor, and the number of animals needed.
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Affiliation(s)
- Zhongmin Li
- Advancecor GmbH, Lochhamerstr. 29 A, 82152, Martinsried, Germany.
| | - Goetz Muench
- Advancecor GmbH, Lochhamerstr. 29 A, 82152, Martinsried, Germany
| | - Clara Wenhart
- Advancecor GmbH, Lochhamerstr. 29 A, 82152, Martinsried, Germany
| | - Silvia Goebel
- Advancecor GmbH, Lochhamerstr. 29 A, 82152, Martinsried, Germany
| | - Andreas Reimann
- Advancecor GmbH, Lochhamerstr. 29 A, 82152, Martinsried, Germany
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Belen E, Ozkurt H, Yanc U. Multidetector Computer Tomography Angiography Protocol in the Context of Transcatheter Aortic Valve Implantation. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:177-181. [PMID: 35990299 PMCID: PMC9350053 DOI: 10.14744/semb.2022.90836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
Transcatheter aortic valve implantation is a procedure in the context of non-suitable for open surgery. Measurements of aortic root width, aortic valve surface area, and measurements of the aortic tree, coronary vessels, femoral, and subclavian arteries are of critical importance. In the TAVI procedure, the dimensions of the valve to be placed on the patient are determined by the computed tomography method. Appropriate protocols should be selected for coronary scoring and inclusion of coronary arteries in TAVI imaging and after the shooting, images of coronary arteries such as curved MPR and VRT should be processed, and these images should be prepared to guide the physician who will perform the procedure. The device to be used in imaging must be a tomography device with at least 64 MCDT sections. There are two methods for these shots using ECG triggering. These methods are as follows: Retrospective scan and prospective scan. Bolus tracking method for TAVI imaging is one of the most accurate contrast giving methods that can be used. Automatic dose calibration is used. With the success of the method day by day, the importance of "Computerized Tomography TAVI," which guides physicians during the method, has increase.
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Affiliation(s)
| | | | - Ugur Yanc
- Address for correspondence: Ugur Yanc, MD. Seyrantepe Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey Phone: +90 530 169 44 35 E-mail:
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Stastny L, Krapf C, Dumfarth J, Gasser S, Bauer A, Friedrich G, Metzler B, Feuchtner G, Mayr A, Grimm M, Bonaros N. Minireview: Transaortic Transcatheter Aortic Valve Implantation: Is There Still an Indication? Front Cardiovasc Med 2022; 9:798154. [PMID: 35310977 PMCID: PMC8931192 DOI: 10.3389/fcvm.2022.798154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Transaortic (TAo) transcatheter aortic valve implantation has become a valid alternative access route in patients with unsuitable femoral arteries. The current literature does not allow to clearly favor one of the alternative access routes. Every approach has its specific advantages. Transaortic (TAo) access is of particular importance in the case of calcifications of the supra-aortic branches and the aortic arch, as under these circumstances other alternative access routes, such as transaxillary or transcarotid, are not feasible. The purpose of this minireview is to give an overview and update on TAo transcatheter aortic valve implantation focusing on indication, technical aspects, and recent clinical data.
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Affiliation(s)
- Lukas Stastny
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Krapf
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
- *Correspondence: Julia Dumfarth
| | - Simone Gasser
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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Miyoshi K, Onoda H, Tanabe M, Nakao S, Higashi M, Iida E, Okada M, Furukawa M, Ito K. Image quality in dual-source multiphasic dynamic computed tomography of the abdomen: evaluating the effects of a low tube voltage (70 kVp) in combination with contrast dose reduction. Abdom Radiol (NY) 2020; 45:3755-3762. [PMID: 32382819 DOI: 10.1007/s00261-020-02565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the image quality of multiphasic (arterial, portal, and equilibrium phases) dynamic computed tomography (CT) of the abdomen obtained by a low tube voltage (70kVp) in combination with a half-dose iodine load using low-concentration contrast agent in high tube output dual-source CT with a standard tube voltage (120kVp) and full-dose iodine load using the same group of adult patients. METHODS Fifty-five patients who underwent both low-tube-voltage (70kVp) abdominal CT with a half-dose iodine load and standard-tube-voltage (120kVp) CT with a full-dose iodine load were analyzed. The mean CT values and signal-to-noise ratio (SNR) of the liver, aorta and portal veins were quantitatively assessed. In addition, the contrast enhancement of the abdominal organs and overall image quality were qualitatively evaluated. RESULTS The mean CT values and SNR of the liver parenchyma were significantly higher in 70-kVp protocol than in 120-kVp protocol in all 3 phases (p = 0.018 ~ < 0.001). Regarding the qualitative analysis, the overall image quality in the 70-kVp protocol was significantly better than in the 120-kVp protocol in all 3 phases (p < 0.001). In addition, the contrast enhancement scores of the liver parenchyma and hepatic vein in the equilibrium phase were also significantly higher in the 70-kVp protocol than in the 120-kVp protocol (p < 0.001). CONCLUSION A low tube voltage (70kVp) in combination with a half-dose iodine load using a low-concentration contrast agent and an iterative reconstruction algorithm in high tube output dual-source CT may improve the contrast enhancement and image quality in multiphasic dynamic CT of the abdomen in patients under 71 kg of body weight.
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Affiliation(s)
- Keisuke Miyoshi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hideko Onoda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mashiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Sei Nakao
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Etsushi Iida
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Munemasa Okada
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Matakazu Furukawa
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
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Strong C, Ferreira A, Teles RC, Mendes G, Abecasis J, Cardoso G, Guerreiro S, Freitas P, Santos AC, Saraiva C, Brito J, Raposo L, Gonçalves PDA, Gabriel HM, Almeida MDS, Mendes M. Diagnostic accuracy of computed tomography angiography for the exclusion of coronary artery disease in candidates for transcatheter aortic valve implantation. Sci Rep 2019; 9:19942. [PMID: 31882777 PMCID: PMC6934755 DOI: 10.1038/s41598-019-56519-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/10/2019] [Indexed: 01/02/2023] Open
Abstract
Coronary CT angiography (CTA) is currently considered a reliable method to exclude obstructive coronary artery disease (CAD) before valvular heart surgery in patients with low pretest probability. However, its role in excluding obstructive CAD before transcatheter aortic valve implantation (TAVI) is less well established. Single-center retrospective study where patients with severe symptomatic aortic stenosis underwent both CTA and invasive coronary angiography (ICA) as part of TAVI planning. CTA exams were conducted on a 64-slice dual source scanner, with a median interval of 45 days to ICA (IQR 25–75 [13–82]). In both tests, obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel ≥2 mm diameter. Per-patient, per-vessel and per-proximal segment analyses were conducted, excluding and including non-evaluable segments. The study included 200 patients (120 women, mean age 83 ± 6 years). The prevalence of obstructive CAD on ICA was 35.5% (n = 71). On a per-patient analysis (assuming non-evaluable segments as stenotic), CTA showed sensitivity of 100% (95% CI, 95–100%), specificity of 42% (95% CI, 33–51%), and positive and negative predictive values of 48% (95% CI, 44–51%) and 100% (95% CI, 92–100%), respectively. CTA was able to exclude obstructive CAD in 54 patients (27%), in whom ICA could have been safely withheld. Despite the high rate of inconclusive tests, pre-procedural CTA is able to safely exclude obstructive CAD in a significant proportion of patients undergoing TAVI, possibly avoiding the need for ICA in roughly one quarter of the cases.
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Affiliation(s)
- Christopher Strong
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal.
| | - António Ferreira
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Gustavo Mendes
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - João Abecasis
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Gonçalo Cardoso
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Sara Guerreiro
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Pedro Freitas
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | | | - Carla Saraiva
- Hospital de Santa Cruz, Radiology department, Lisboa, 2790-134, Portugal
| | - João Brito
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | - Luís Raposo
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
| | | | | | | | - Miguel Mendes
- Hospital de Santa Cruz, Cardiology department, Lisboa, 2790-134, Portugal
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Zhang H, Shen Y, Zhang L, Song C, Jing Z, Lu Q. Preoperative evaluation of transcatheter aortic valve replacement with assistance of 3D printing technique: Reanalysis of 4 death cases. J Interv Med 2019; 2:166-170. [PMID: 34805896 PMCID: PMC8562219 DOI: 10.1016/j.jimed.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) can have some fatal complications during and after the operation. Until recently, pre-procedural imaging with cardiac computed tomography (CT), which is required to evaluate for TAVR, had its own imperfections. We aimed to determine whether 3D printed models can predict complications when other pre-procedural imaging techniques failed. METHODS Vascular center patients with aortic valve stenosis, who died after TAVR between June 2011 and June 2016, were enrolled in this retrospective study. The CT datasets of the patients were imported into a three-dimensional (3D) construction software and then printed by flexible material. To predict complications during and after operations, we designed a release test using the non-valved stent mode that was consistent with the Edwards Sapien XT valve in size and radial support force. RESULT The 3D model predicted the coronary obstruction and annular rupture in the in vitro release process, which was consistent with what happened in the actual operation. CONCLUSION Three-dimensional modeling facilitates pre-operative assessment of patients receiving TAVR, with accurate simulation of intraoperative status.
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Affiliation(s)
- Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China.,Department of General Surgery, No. 202, Hospital of People's Liberation Army, 5Guangrong Road, Shenyang, Liaoning, 110812, PR China
| | - Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168Changhai Road, Shanghai, 200433, PR China
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Baliyan V, Shaqdan K, Hedgire S, Ghoshhajra B. Vascular computed tomography angiography technique and indications. Cardiovasc Diagn Ther 2019; 9:S14-S27. [PMID: 31559151 DOI: 10.21037/cdt.2019.07.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the vascular disease processes. Computed tomography angiography (CTA) is an imaging method of choice for a wide range of vascular diseases that span across different vascular territories. A diagnostic quality CTA requires a robust imaging protocol tailored according to the physiologic state and vascular area of interest. This review article is aimed to provide an overview of the technical considerations and clinical applications of CTA.
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Affiliation(s)
- Vinit Baliyan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Khalid Shaqdan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep Hedgire
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Talei Franzesi CR, Ippolito D, Riva L, Fior D, Cangiotti C, Sironi S. Diagnostic value of iterative reconstruction algorithm in low kV CT angiography (CTA) with low contrast medium volume for transcatheter aortic valve implantation (TAVI) planning: image quality and radiation dose exposure. Br J Radiol 2018; 91:20170802. [PMID: 30074831 PMCID: PMC6319841 DOI: 10.1259/bjr.20170802] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE: To evaluate image quality and radiation dose exposure of low-kV (100 kV) and low contrast medium (CM) volume CT angiography (CTA) in patients candidate to Transcatheter Aortic Valve Implantation (TAVI), in comparison with standard CTA protocol. METHODS: 79 patients candidate for TAVI were prospectively enrolled in this study and examined with 256-MDCT. 42 patients were evaluated using study-group protocol (100 kV; whole-body retrospective ECG-gating; with 50 ml of CM; iterative reconstruction algorithm) while 37 patients underwent a standard CTA study (120 kV; ECG-gating for chest; 100 ml of CM; FBP reconstruction). Overall image quality was evaluated using a 4-point scale. Vascular enhancement (HU) was then assessed in each patient by manually drawing multiple ROIs in lumen of 7 segments of the whole aorta. The radiation dose exposure of both groups was calculated and all data were compared and statistically analyzed. RESULTS: On low-kV protocol, higher mean attenuation values were achieved in all the measurements as compared to standard protocol. There were no significant differences in the image quality evaluation in both groups. Mean radiation dose value of study group was significantly lower than in control group (reduction of 20%). CONCLUSION: Low kV and low CM volume CTA protocols allow TAVI planning to be carried out with high quality images and a significant reduction in the radiation dose as compared to the standard CTA protocol. ADVANCES IN KNOWLEDGE: Low-kV CTA for pre-operative assessment of patients candidates for TAVI, permits to achieve a significant reduction of radiation dose exposure and contrast medium volume, reducing the risk of contrast induced nephropathy.
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Lama N, Patris V, Fagkrezos D, Moschouris P, Giakoumidakis K, Triantopoulou C, Maniatis P, Argiriou M. Radiopaque preventive landmarks' placement during stentless bioprosthesis implantation. J Thorac Dis 2018; 10:3158-3165. [PMID: 30069311 DOI: 10.21037/jtd.2018.06.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In patients with aortic stenosis, bioprosthetic valves are increasingly used. Although their benefits, they are also presenting limitations, as their time-related degeneration. Reoperation which was, until a few years ago, the only treatment for this condition, carries a significant surgical risk, especially in patients with multiple comorbidities, so the benefit of less invasive technique enabling the implantation of aortic valve prosthesis [transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV)] by a percutaneous access is remarkably important. Eligible patients are judged by a heart team, and imaging plays a key role in this selection, focusing on correct identification of bioprosthetic aortic valves type and size, evaluation of patients at increased anatomical risk for coronary artery occlusion. Radiolucency of stentless bioprosthetic valves, represent a significant challenge. Methods Surgical aortic valve replacements (SAVRs) with a bioprosthesis were performed using a stentless valve with no radiopaque components (Solo Smart, Sorin). The chosen method, in order to evaluate the results of the operation, was computed tomography (CT) scanning (64-slice MDCT, Brilliance, Philips). The study consisted of a thin sliced contrast electrocardiograph (ECG) gated chest CT (1 systolic cardiac phase), trying to simulate the required assessment of aortic root and the radiopaque placed markers. Results As surgical implant technique varies and may impact the relationship of the prosthetic annulus to the coronary ostia, marking the aortic annulus during the operation in order to have some useful radiopaque landmarks, is a great assistance promoting better orientation and correct identification of the position of the bioprosthetic valve. Although the implantation of metallic vascular clips at the level of aortic annulus (in any commissure or in the middle of any cups) was considered, the decision was to position three metallic clips bellow the aortic annulus in the three stiches ligated during the solo valve implantation. Conclusions We are suggesting the preventive implantation of radiopaque landmarks, during SAVRs using tissue valves which are lacking fixed anatomic markers, as a guide for a presumptive TAV-in-SAV procedure, keeping in mind that appropriate guidance is crucial and can prevent valve misplacement, coronary obstruction and other potentially lethal complications.
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Affiliation(s)
- Niki Lama
- Department of Computed Tomography, "Konstantopouleio" General Hospital of Athens, Athens, Greece
| | - Vasileios Patris
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Dimitrios Fagkrezos
- Department of Radiology, "Konstantopouleio" General Hospital of Athens, Athens, Greece
| | - Petros Moschouris
- Department of Computed Tomography, "Konstantopouleio" General Hospital of Athens, Athens, Greece
| | | | | | - Petros Maniatis
- Department of Computed Tomography, "Konstantopouleio" General Hospital of Athens, Athens, Greece
| | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
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11
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Al WA, Jung HY, Yun ID, Jang Y, Park HB, Chang HJ. Automatic aortic valve landmark localization in coronary CT angiography using colonial walk. PLoS One 2018; 13:e0200317. [PMID: 30044802 PMCID: PMC6059446 DOI: 10.1371/journal.pone.0200317] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/21/2018] [Indexed: 11/18/2022] Open
Abstract
The minimally invasive transcatheter aortic valve implantation (TAVI) is the most prevalent method to treat aortic valve stenosis. For pre-operative surgical planning, contrast-enhanced coronary CT angiography (CCTA) is used as the imaging technique to acquire 3-D measurements of the valve. Accurate localization of the eight aortic valve landmarks in CT images plays a vital role in the TAVI workflow because a small error risks blocking the coronary circulation. In order to examine the valve and mark the landmarks, physicians prefer a view parallel to the hinge plane, instead of using the conventional axial, coronal or sagittal view. However, customizing the view is a difficult and time-consuming task because of unclear aorta pose and different artifacts of CCTA. Therefore, automatic localization of landmarks can serve as a useful guide to the physicians customizing the viewpoint. In this paper, we present an automatic method to localize the aortic valve landmarks using colonial walk, a regression tree-based machine-learning algorithm. For efficient learning from the training set, we propose a two-phase optimized search space learning model in which a representative point inside the valvular area is first learned from the whole CT volume. All eight landmarks are then learned from a smaller area around that point. Experiment with preprocedural CCTA images of TAVI undergoing patients showed that our method is robust under high stenotic variation and notably efficient, as it requires only 12 milliseconds to localize all eight landmarks, as tested on a 3.60 GHz single-core CPU.
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Affiliation(s)
- Walid Abdullah Al
- Division of Computer and Electronic Systems Engineering, Hankuk University of Foreign Studies, Yongin, South Korea
| | - Ho Yub Jung
- Department of Computer Engineering, Chosun University, Gwangju, South Korea
- * E-mail:
| | - Il Dong Yun
- Division of Computer and Electronic Systems Engineering, Hankuk University of Foreign Studies, Yongin, South Korea
| | - Yeonggul Jang
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Hyung-Bok Park
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Cardiovascular Center, Myongji Hospital, Seonam University College of Medicine, Goyang, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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12
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Abstract
Non-invasive imaging of the aorta has undergone considerable advancements in recent times; largely driven by the technological advances in computed tomography (CT) and magnetic resonance imaging (MRI). This review article highlights these recent advancements and discusses the current role of different imaging tools in the management of aortic diseases.
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Affiliation(s)
- Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Verdini
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nandini M Meyersohn
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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13
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Chourdakis E, Koniari I, Kounis NG, Velissaris D, Koutsogiannis N, Tsigkas G, Hauptmann KE, Sontag B, Hahalis G. The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients. J Geriatr Cardiol 2018; 15:86-94. [PMID: 29434630 PMCID: PMC5803542 DOI: 10.11909/j.issn.1671-5411.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/06/2018] [Accepted: 01/13/2018] [Indexed: 12/13/2022] Open
Abstract
The transcatheter aortic valve implantation (TAVI) consist an alternative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography (TTE) or transesophageal echocardiography (TOE) and multislice CT (MSCT) constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional (2D) echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques (MSCT, MRI and 3D TOE). Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.
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Affiliation(s)
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | - Nicholas G Kounis
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University Hospital of Patras, Rion, Patras, Greece
| | | | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
| | | | - Bruno Sontag
- Krankenhaus der Barmherzigen Brüder Trier, Germany
| | - George Hahalis
- Department of Cardiology, University Hospital of Patras, Rion, Patras, Greece
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14
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Eberhard M, Mastalerz M, Pavicevic J, Frauenfelder T, Nietlispach F, Maisano F, Tanner FC, Nguyen-Kim TDL. Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 2017; 33:1637-1651. [DOI: 10.1007/s10554-017-1180-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
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15
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Gao X, Kitslaar PH, Budde RPJ, Tu S, de Graaf MA, Xu L, Xu B, Scholte AJHA, Dijkstra J, Reiber JHC. Automatic detection of aorto-femoral vessel trajectory from whole-body computed tomography angiography data sets. Int J Cardiovasc Imaging 2016; 32:1311-22. [PMID: 27209285 DOI: 10.1007/s10554-016-0901-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/22/2016] [Indexed: 12/19/2022]
Abstract
Extraction of the aorto-femoral vessel trajectory is important to utilize computed tomography angiography (CTA) in an integrated workflow of the image-guided work-up prior to trans-catheter aortic valve replacement (TAVR). The aim of this study was to develop a new, fully-automated technique for the extraction of the entire arterial access route from the femoral artery to the aortic root. An automatic vessel tracking algorithm was first used to find the centerline that connected the femoral accessing points and the aortic root. Subsequently, a deformable 3D-model fitting method was used to delineate the lumen boundary of the vascular trajectory in the whole-body CTA dataset. A validation was carried out by comparing the automatically obtained results with semi-automatically obtained results from two experienced observers. The whole framework was validated on whole body CTA datasets of 36 patients. The average Dice similarity indexes between the segmentations of the automatic method and observer 1 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta were 0.977 ± 0.030, 0.980 ± 0.019, 0.982 ± 0.016; the average Dice similarity indexes between the segmentations of the automatic method and observer 2 were 0.950 ± 0.040, 0.954 ± 0.031 and 0.965 ± 0.019, respectively. The inter-observer variability resulted in a Dice similarity index of 0.954 ± 0.038, 0.952 ± 0.031 and 0.969 ± 0.018 for the left ilio-femoral artery, the right ilio-femoral artery and the aorta. The average minimal luminal diameters (MLDs) of the ilio-femoral artery were 6.03 ± 1.48, 5.70 ± 1.43 and 5.52 ± 1.32 mm for the automatic method, observer 1 and observer 2 respectively. The MLDs of the aorta were 13.43 ± 2.54, 12.40 ± 2.93 and 12.08 ± 2.40 mm for the automatic method, observer 1 and observer 2 respectively. The automatic measurement overestimated the MLD slightly in the ilio-femoral artery at the average by 0.323 mm (SD = 0.49 mm, p < 0.001) compared to observer 1 and by 0.51 mm (SD = 0.71 mm, p < 0.001) compared to observer 2. The proposed segmentation approach can automatically provide reliable measurements of the entire arterial accessing route that can be used to support TAVR procedures. To the best of our knowledges, this approach is the first fully automatic segmentation method of the whole aorto-femoral vessel trajectory in CTA images.
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Affiliation(s)
- Xinpei Gao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands.
- Medis medical imaging systems b.v., Leiden, The Netherlands.
| | - Ricardo P J Budde
- Department of Radiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Xu
- Catheterization Laboratory, National Center for Cardiovascular Diseases of China and Fu Wai Hospital, Beijing, China
| | - Bo Xu
- Catheterization Laboratory, National Center for Cardiovascular Diseases of China and Fu Wai Hospital, Beijing, China
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands
- Medis medical imaging systems b.v., Leiden, The Netherlands
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16
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Schoenhagen P, Zimmermann M, Falkner J. Advanced 3-D analysis, client-server systems, and cloud computing-Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement. Cardiovasc Diagn Ther 2013; 3:80-92. [PMID: 24282750 DOI: 10.3978/j.issn.2223-3652.2013.02.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/25/2013] [Indexed: 11/14/2022]
Abstract
Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR.
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αB-crystallin regulates oxidative stress-induced apoptosis in cardiac H9c2 cells via the PI3K/AKT pathway. Mol Biol Rep 2012; 40:2517-26. [PMID: 23212619 DOI: 10.1007/s11033-012-2332-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 11/20/2012] [Indexed: 01/08/2023]
Abstract
The present study was carried out to observe the protective effects of αB-crystallin protein on hydrogen peroxide (H2O2)-induced injury in rat myocardial cells (H9c2) and to investigate the mechanisms of these protective effects at the cellular level, which could provide the experimental basis for future applications of αB-crystallin in the treatment of cardiovascular disease. Western blotting was used to measure the expression of αB-crystallin in cultured H9c2 cells in vitro. A αB-crystallin recombinant expression vector, pcDNA3.1-Cryab, was constructed to transfect H9c2 cells for the establishment of cells that stably expressed αB-crystallin. A tetrazolium-based colorimetric assay (MTT test) was used to measure changes in the viability of the H9c2 cells at 1, 2, 3 and 4 h after induced by 150 μM H2O2 to establish a model of H2O2 injury to cells. H2O2 was applied to H9c2 cells that were stably transfected with αB-crystallin, and the effect of αB-crystallin overexpression on the viability of myocardial cells subjected to H2O2-induced injury was measured by the MTT assay. The effect of αB-crystallin overexpression on the H2O2-induced injury of H9c2 cells was also analyzed by flow cytometry. The mitochondrial components and cytoplasmic components of H9c2 cells were separated, and western blotting was used to measure the effect of αB-crystallin overexpression on the release of cytochrome c from the mitochondria. Western blotting was also used to measure the effect of αB-crystallin overexpression on the expression of the anti-apoptosis protein Bcl-2 and components of the phosphatidylinositol 3-OH kinase (PI3K)/AKT pathway. The αB-crystallin recombinant expression vector pcDNA3.1-Cryab successfully transfected H9c2 cells, and H9c2 cells that were stably transfected with αB-crystallin were established after G418 selection. The measurements carried out by western blotting showed that αB-crystallin proteins are expressed in normal H9c2 cells, but the proteins' expression was much higher in pcDNA3.1-Cryab transfected cells (P < 0.01). The MTT assays showed that 4 h of H2O2 treatment induced significant injury in H9c2 cells (P < 0.01), but αB-crystallin overexpression can effectively antagonize the H2O2-induced injury to H9c2 cells (P < 0.05). The results of flow cytometry analysis showed that αB-crystallin overexpression can significantly reduce apoptosis in H2O2-injured H9c2 cells (P < 0.05). The results of western blotting showed that αB-crystallin overexpression in myocardial cells can reduce the H2O2-induced release of cytochrome c from the mitochondria (P < 0.05), antagonize the H2O2-induced downregulation of Bcl-2 (P < 0.05) and magnify the decrease in phosphorylated AKT levels induced by H2O2 injury (P < 0.05). The overexpression of αB-crystallin has a protective effect on H2O2-injured H9c2 cells, and αB-crystallin can play a protective role by reducing apoptosis, reducing the release of cytochrome c from the mitochondria and antagonizing the downregulation of Bcl-2 expression. The protective effects of αB-crystallin may be related to the PI3K/AKT pathway.
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Schoenhagen P. Communication of novel concepts. Cardiovasc Diagn Ther 2012; 2:1-2. [PMID: 24282689 PMCID: PMC3839172 DOI: 10.3978/j.issn.2223-3652.2012.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/05/2012] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Schoenhagen
- Cleveland Clinic, Imaging Institute and Heart & Vascular Institute, Cleveland, USA
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Schoenhagen P. Cardiovascular Diagnosis and Therapy (CDT): yet another journal? Cardiovasc Diagn Ther 2011; 1:1-2. [PMID: 24282680 PMCID: PMC3839133 DOI: 10.3978/j.issn.2223-3652.2011.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/26/2011] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Schoenhagen
- Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
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