Document Detail


Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer's guidelines for sizing for percutaneous aortic valve replacement helpful?
MedLine Citation:
PMID:  19995874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To evaluate the effects of applying current sizing guidelines to different multislice computer tomography (MSCT) aortic annulus measurements on Corevalve (CRS) size selection. METHODS AND RESULTS: Multislice computer tomography annulus diameters [minimum: D(min); maximum: D(max); mean: D(mean) = (D(min) + D(max))/2; mean from circumference: D(circ); mean from surface area: D(CSA)] were measured in 75 patients referred for percutaneous valve replacement. Fifty patients subsequently received a CRS (26 mm: n = 22; 29 mm: n = 28). D(min) and D(max) differed substantially [mean difference (95% CI) = 6.5 mm (5.7-7.2), P < 0.001]. If D(min) were used for sizing 26% of 75 patients would be ineligible (annulus too small in 23%, too large in 3%), 48% would receive a 26 mm and 12% a 29 mm CRS. If D(max) were used, 39% would be ineligible (all annuli too large), 4% would receive a 26 mm, and 52% a 29 mm CRS. Using D(mean), D(circ), or D(CSA) most patients would receive a 29 mm CRS and 11, 16, and 9% would be ineligible. In 50 patients who received a CRS operator choice corresponded best with sizing based on D(CSA) and D(mean) (76%, 74%), but undersizing occurred in 20 and 22% of which half were ineligible (annulus too large). CONCLUSION: Eligibility varied substantially depending on the sizing criterion. In clinical practice both under- and oversizing were common. Industry guidelines should recognize the oval shape of the aortic annulus.
Authors:
Carl J Schultz; Adriaan Moelker; Nicolo Piazza; Apostolos Tzikas; Amber Otten; Rutger J Nuis; Lisan A Neefjes; Robert J van Geuns; Pim de Feyter; Gabriel Krestin; Patrick W Serruys; Peter P T de Jaegere
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-12-07
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-02     Completed Date:  2010-09-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  849-56     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Aortic Valve / pathology,  radiography*
Aortic Valve Stenosis / pathology,  radiography*
Female
Health Care Sector
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Imaging, Three-Dimensional
Male
Organ Size
Practice Guidelines as Topic
Prosthesis Design
Prosthesis Fitting / methods
Tomography, X-Ray Computed / methods*

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