Document Detail


Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation.
MedLine Citation:
PMID:  20451695     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transcatheter aortic valve implantation (TAVI) without replacement requires precise knowledge of the anatomic dimensions and physical characteristics of the peripheral vasculature and aortic valve annulus at the insertion of the aortic valve leaflet and root at the level of the sinus of Valsalva. Multislice computed tomography (CT) allows detailed and precise assessment of the anatomic variables. Noncardiovascular structures are also amenable to assessment by CT. Of the 394 patients screened for TAVI, 259 (65.7%) had non-contrast CT to evaluate chest anatomy and contrast CT to evaluate ilio-femoral anatomy. Significant noncardiac findings were defined as those requiring immediate evaluation or intervention or additional clinical or radiologic follow-up. Noncardiovascular findings known before CT were not included. Of the 259 patients, 105 (40.5%) were men. The mean age was 82.3 +/- 8.1 years. New, significant noncardiovascular findings were found in 89 (34.3%) and malignancy in 11 (4.2%) patients. Insignificant noncardiovascular findings were identified in 222 patients (85.7%). Signs of fluid retention were noted on CT in 105 patients (40.5%), with pleural effusion in 100 (38.6%), ascites in 17 (6.5%), and pericardial effusion in 14 (5.4%). Important peripheral vascular disease was found in 98 patients (37.8%), resulting in exclusion of 49 (19.1%) from TAVI using the transfemoral approach. An aortic aneurysm was found in 10 patients (3.8%) and a "porcelain" aorta (heavily calcified ascending aorta) in 19 (7.3%). In conclusion, malignancy and other noncardiovascular abnormalities are often found in patients who undergo CT for evaluation for TAVI. Populations must be meticulously examined to ensure that important findings are not missed.
Authors:
Itsik Ben-Dor; Ron Waksman; Nicholas N Hanna; Arnold Raizon; Lowell F Satler; Rebecca Torguson; Gaby Weissman; Petros Okubagzi; Zhenyi Xue; Yanlin Li; Manuel A Gonzalez; Gabriel Maluenda; Michael A Gaglia; Kohei Wakabayashi; Cedric Delhaye; Asmir I Syed; Sara D Collins; William O Suddath; Kenneth M Kent; Joseph Lindsay; Augusto D Pichard
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-04-02
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1461-4     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Washington Hospital Center, Washington, District of Columbia, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve Stenosis / diagnosis,  epidemiology,  surgery*
Catheterization, Peripheral / adverse effects,  methods
Cohort Studies
Comorbidity*
Female
Follow-Up Studies
Geriatric Assessment
Heart Catheterization / methods*
Heart Valve Prosthesis Implantation / methods*,  mortality
Humans
Male
Neoplasms / epidemiology,  radiography
Patient Selection
Peripheral Vascular Diseases / epidemiology,  radiography
Pleural Effusion / epidemiology,  radiography
Risk Assessment
Severity of Illness Index
Survival Analysis
Tomography, X-Ray Computed / methods*
Treatment Outcome

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


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