| Multislice computed tomography for prediction of optimal angiographic deployment projections during transcatheter aortic valve implantation. | |
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MedLine Citation:
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PMID: 21087752 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study assessed whether multislice computed tomography (MSCT) could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI). BACKGROUND: Accurate device positioning during TAVI depends on valve deployment in angiographic projections perpendicular to the native valve plane, but these may be difficult to determine. METHODS: Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple angiographic projections accurately representing the native valve plane in multiple axes were determined. The accuracy of all predicted projections was determined post-procedure using angiography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction. RESULTS: Correct final deployment projections were more frequent in the MSCT-guided compared with non-MSCT-guided group: excellent or satisfactory projections (90% vs. 65%, p = 0.06). The MSCT angle prediction was accurate but dependent on optimal images (optimal images: 93% of predicted angles were excellent or satisfactory, suboptimal images: 73% of predicted angles were poor). A "line of perpendicularity" could be generated with optimal projections across the right-to-left anterior oblique plane by adding the correct cranial or caudal angulation. CONCLUSIONS: Pre-procedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or "line of perpendicularity" can be generated. Understanding and applying these principles improves the accuracy of valve deployment and may improve outcomes. |
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Authors:
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Ronen Gurvitch; David A Wood; Jonathon Leipsic; Edgar Tay; Mark Johnson; Jian Ye; Fabian Nietlispach; Namal Wijesinghe; Anson Cheung; John G Webb |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular interventions Volume: 3 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-22 Completed Date: 2011-03-04 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: 1157-65 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 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, British Columbia, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Valve Stenosis / radiography*, therapy* British Columbia Chi-Square Distribution Female Heart Catheterization / instrumentation Heart Valve Prosthesis Heart Valve Prosthesis Implantation / instrumentation, methods* Humans Male Predictive Value of Tests Radiographic Image Interpretation, Computer-Assisted Tomography, X-Ray Computed* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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