Document Detail


Assessment of annular distensibility in the aortic valve.
MedLine Citation:
PMID:  22695515     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES The recent introduction of transcatheter aortic heart valves into clinical practice has driven the need to develop methodologies to size such valves without access to the annulus in the manner hitherto possible with open heart surgery. To date, sizing has largely been done according to manufacturer-supplied guidelines based on transoesophageal echocardiography or multidetector computed tomography. We sought to examine how the diameter of the aortic valve annulus stretches under typical pressures encountered in normal and diseased states. In particular, we sought to measure how the area-derived diameter, Dcsa, i.e. the diameter derived from a cross-sectional area, varies with distending pressure. METHODS We conducted testing on 14 explanted pig hearts. Placing each heart in a 37 °C bath, an EndoFLIP EF-325 catheter (Crospon, Galway, Ireland) was introduced into the aortic valve transapically. The catheter allows intra-balloon pressure and up to 16 area-derived diameters to be measured simultaneously, thus permitting the shape of a lumen to be observed. By dividing the minimum area-derived diameter by distending pressure, a measure of distensibility (mm/mmHg) could be determined. Once the balloon was centred, balloon pressure was ramped between 100 and 200 mmHg, and the area-derived diameter was calculated at each pressure. RESULTS Between 100 and 200 mmHg, the mean (SD) increase in diameter was found to be 3.0 (1.5) mm. Distensibility in the different hearts ranged from 0 to 0.05 mm/mmHg. In some cases, the diameter change over the pressure range was negligible, whereas in one case, the diameter change over the range was 5 mm. Whereas different nominal values of diameter are to be expected, a significant variation in the degree of distensibility was observed. CONCLUSIONS Distensibility of the aortic valve annulus is highly variable. Measurement of this parameter in addition to nominal annulus diameter may suggest occasions where a larger transcatheter aortic-valve implantation valve than would be suggested by annulus diameter measurement alone, could be deployed safely with an objective of reducing regurgitation where the annulus is sufficiently distensible.
Authors:
John O'Dea; David J Nolan
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-13
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-21     Completed Date:  2013-01-17     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  361-3     Citation Subset:  IM    
Affiliation:
School of Engineering and Informatics, National University of Ireland, Galway, Ireland. j.odea1@nuigalway.ie
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MeSH Terms
Descriptor/Qualifier:
Animals
Aortic Valve / physiopathology*,  surgery,  ultrasonography
Aortic Valve Insufficiency / diagnosis,  surgery*
Aortic Valve Stenosis / diagnosis,  surgery*
Biomechanics
Cardiac Catheterization
Disease Models, Animal
Echocardiography, Transesophageal
Heart Valve Prosthesis*
Multidetector Computed Tomography
Pilot Projects
Prosthesis Design
Swine
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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