Author + information
- Won–Jang Kim,
- Ho–Cheol Kim,
- Yong–Rak Cho,
- Jung–Min Ahn,
- Jong–Yong Lee,
- Duk–Woo Park,
- Soo–Jin Kang,
- Seung–Whan Lee,
- Young–Hak Kim,
- Cheol Whan Lee,
- Seong–Wook Park and
- Seung–Jung Park
To determine the most reproducible cardiac computed tomography (CCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation (TAVI).
Annular measurements were performed in 50 patients planed for TAVI in multiple planes: coronal, sagittal, 3–chamber, basal ring (short–and long–axis, mean diameter, area–derived diameter, perimeter) projection, and inter–commissure dimension (sine rule using 3–dimensional). A theoretical model was developed taking into account the differences between the most reproducible CCT measurements and transesophageal echocardiography to guide valve size choice.
The most reproducible measurements were the area–derived diameter and basal ring average diameter (inter–reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve–sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively).
The most reproducible MDCT measurements of the annulus are the area–derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–241
- 2013 American College of Cardiology Foundation