| Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation. | |
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MedLine Citation:
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PMID: 22115665 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation. BACKGROUND: The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear. METHODS: Annular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice. RESULTS: The most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively). CONCLUSIONS: The most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive. |
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Authors:
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Ronen Gurvitch; John G Webb; Ren Yuan; Mark Johnson; Cameron Hague; Alexander B Willson; Stefan Toggweiler; David A Wood; Jian Ye; Robert Moss; Christopher R Thompson; Stephan Achenbach; James K Min; Troy M Labounty; Ricardo Cury; Jonathon Leipsic |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular interventions Volume: 4 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-25 Completed Date: 2012-03-25 Revised Date: 2012-08-29 |
Medline Journal Info:
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Nlm Unique ID: 101467004 Medline TA: JACC Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 1235-45 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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St. Paul's Hospital, University of British Columbia, Vancouver, Canada. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Valve / radiography*, ultrasonography Chi-Square Distribution Echocardiography, Transesophageal Female Heart Catheterization* / instrumentation Heart Valve Diseases / radiography*, therapy*, ultrasonography Heart Valve Prosthesis Heart Valve Prosthesis Implantation / instrumentation, methods* Humans Male Models, Cardiovascular Patient Selection Predictive Value of Tests Prosthesis Design Reproducibility of Results Tomography, X-Ray Computed* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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