IntroductionTranscatheter aortic valve implantation (TAVI) improves prognosis in patients disqualified from surgical valve replacement. Calcifications of the aortic complex can lead to deformation of the prosthesis, resulting in paravalvular leaks (PVL).AimTo evaluate the predictive value of quantitative estimation of volume/weight and geometric distribution of calcifications in multislice computed tomography, for the development of PVL.Material and methodsThis was a retrospective, case-control study on patients with a CoreValve aortic prosthesis. The study group consisted of 20 patients with confirmed significant PVL after TAVI. The control group consisted of 20 patients without significant PVL, matched according to valve type and clinical characteristics. The size spatial distribution and shape of calcifications were measured.ResultsThe average age of patients was 79.9 years (60% women). Cases and controls did not differ in their clinical characteristics. The size of the aortic annulus was significantly larger in cases vs. controls (23.4 ±1.6 vs. 22 ±1.4 mm, p = 0.01). Volume, area and curvature of calcifications were greater in cases vs controls (1.09 ±0.56 vs. 0.59 ±0.41 cm3, p = 0.011; 15.26 ±5.46 vs. 9.50 ±5.29 cm2, p = 0.008; 1.76 ±0.07 vs. 1.68 ±0.13 cm3, p = 0.037). In multivariate analysis, adjusted for aortic annulus size, the area of aortic valve calcifications independently predicted paravalvular regurgitation (OR = 1.41, 95% CI: 0.09–1.92, p < 0.009).ConclusionsMorphometric analysis of aortic valve calcifications predicted the risk of paravalvular leak following TAVI irrespectively of patients’ clinical characteristics.

IDFM reclassified a substantial proportion of patients with severe AS into potentially moderate AS group and from low-flow to normal-flow AS group. Such regrouping calls for increased diagnostic prudence in AS patients, especially those with specific clinical and echocardiographic predictors of reclassification, such as DM or low AMG.

The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age-and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.

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Introduction Calcified aortic stenosis (AS) and mitral annular calcification (MAC) have similar etiology and pathophysiological mechanisms. Half of all patients undergoing transcatheter aortic valve implantation (TAVI) have MAC. Several studies assessed the role of mitral regurgitation (MR) following TAVI but only few examined influence of MAC on its changes after TAVI. MAC frequently coexists with the calcification of mitro-aortic continuity (CMAC). Purpose Presence of CMAC may influence the results of TAVI, especially in the case of deeper implantation, protruding to let ventricular outflow tract (LVOT). In the present study we aimed at qualitative and semi-quantitative analysis of calcifications of the mitral complex – MAC and CMAC in multi-slice computed tomography (MSCT) in patients qualified to TAVI, in order to assess their impact on the occurrence and dynamics of MR following aortic valve implantation. Methods MAC was assessed quantitatively (Calcium Score) and semi-quantitative scale in depending on the degree of annular involvement. CMAC was evaluated in semi-quantitatively scale in depending on length of calcifications in the largest dimension. Subsequently patients were classified in a dichotomous manner as having non-severe or severe MAC and CMAC. All patients underwent transthoracic echocardiographic examinations prior to the procedure and after TAVI. Changes of MR severity following TAVI were defined as no change, improvement or worsening by at least one degree. Results The study group consisted of 94 patients. Fifty six (59.6%) out of 94 patients had MAC and 21 patients (22.3%) had severe MAC. Patients with MAC had higher mean aortic gradients (54.07±13,62 mmHg vs 46.79±14.42 mmHg, p=0.02) and smaller left ventricular diastolic diameter (46.09±6.86 mm vs 51.19±8.42 mm, p=0.002). Almost half of the patients - 46 (48.9%) had CMAC and 12 patients (12.8%) had severe CMAC. Patients with CMAC had higher Calcium Score Aortic Valve (3773.67±1734.02 Hounsfield Units (HU) vs 2875.1±1352.76 HU, p=0.006) and smaller AVA (0.59±0.16 cm2 vs 0.66±0.20 cm2, p=0.052). Before TAVI 35.1% of patients had more than mild MR. MR improved by at least one grade following TAVI in 17 (18.1%) patients and worsened by at least one grade in 7 (7.5%) patients. In multivariable logistic regression analysis MR worsening was associated with higher CMAC [OR 1.092, 95% CI: 1.006–1.185, p=0.035]. Conclusions The study demonstrated CMAC is prevalent in patients undergoing TAVI. CMAC was associated with MR worsening. This is a novel finding, which may be particular importance in patients with severe AS and coexisting MR in whom arguments for and against surgical repair of concomitant mitral insufficiency are considered, as opposed to isolated aortic valve procedure. Funding Acknowledgement Type of funding source: None