Document Detail


Role of multislice computed tomography in transcatheter aortic valve replacement.
MedLine Citation:
PMID:  19406275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transcatheter aortic valve replacement (TAVR) required precise knowledge of the anatomic dimensions and physical characteristics of the aortic valve, annulus, and aortic root. Most groups currently use angiography, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) to assess aortic annulus dimensions and anatomy. However, multislice computed tomography (MSCT) may allow more detailed 3-dimensional assessment of the aortic root. Twenty-six patients referred for TAVR underwent MSCT. Scans were also obtained for 18 patients after TAVR. All patients underwent pre- and postprocedural aortic root angiography, TTE, and TEE. Mean differences in measured aortic annular diameters were 1.1 mm (95% confidence interval 0.5, 1.8) for calibrated angiography and TTE, -0.9 mm (95% confidence interval -1.7, -0.1 mm) for TTE and TEE, -0.3 mm (95% confidence interval -1.1, 0.6 mm) for MSCT (sagittal) and TTE, and -1.2 mm (95% confidence interval -2.2, -0.2 mm) for MSCT (sagittal) and TEE. Coronal systolic measurements using MSCT, which corresponded to angiographic orientation, were 3.2 mm (1st and 3rd quartiles 2.6, 3.9) larger than sagittal systolic measurements, which were in the same anatomic plane as standard TTE and TEE views. There was no significant association between either shape of the aortic annulus or amount of aortic valve calcium and development of perivalvular aortic regurgitation. After TAVR, the prosthesis extended to or beyond the inferior border of the left main ostium in 9 of 18 patients (50%), and in 11 patients (61%), valvular calcium was <5 mm from the left main ostium. In conclusion, MSCT identified that the aortic annulus was commonly eccentric and often oval. This may in part explain the small, but clinically insignificant, differences in measured aortic annular diameters with other imaging modalities. MSCT after TAVR showed close proximity of both the prosthesis and displaced valvular calcium to the left main ostium in most patients. Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR.
Authors:
David A Wood; Laurens F Tops; John R Mayo; Sanjeevan Pasupati; Martin J Schalij; Karin Humphries; May Lee; Abdullah Al Ali; Brad Munt; Rob Moss; Christopher R Thompson; Jeroen J Bax; John G Webb
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-01     Completed Date:  2009-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1295-301     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / radiography*,  surgery*,  ultrasonography
Cohort Studies
Echocardiography / methods
Echocardiography, Transesophageal / methods
Female
Follow-Up Studies
Heart Catheterization / methods
Heart Valve Diseases / diagnosis,  surgery
Heart Valve Prosthesis Implantation / methods*
Humans
Imaging, Three-Dimensional / methods*
Male
Middle Aged
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Surgical Procedures, Minimally Invasive / methods
Tomography, X-Ray Computed / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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