Aortic Annulus Diameter Determination by Multidetector Computed Tomography: Reproducibility, Applicability and Implications for Transcatheter Aortic Valve Replacement

Abstract

S Heart, Lung and CirculationAbstracts S159 2011;20S:S156-S251 incentive survey with 65 multichoice questions covering all aspects of the service (indications, contraindications, image settings, safety, echo lab workforce and workflow issues and clinical relevance). These answers and a free text option were analysed to assess the program and to determine whether this survey method may be an adequate quality control measure. This survey was approved by the hospital's Human Research Ethics Committee.Results: Of the 54 staff invited to participate, 31 (55%) responded. Ninety-seven percent agreed contrast can improve image quality and improve assessment for LV non compaction (93%), LV thrombus (93%), LV morphology (90%), enhance spectral Doppler signals (70%) and RV function (44%). Seventy-four percent reported contrast results altered patient management. Eighty-two percent reported it increased confidence in echocardiographic findings. However, 60% felt contrast echo slowed down workflow through the department.Conclusion: The online survey technique proved an effective and efficient method to obtain, organise and interpret data in those who did respond. The 55% response rate was disappointing but higher than usual for comparable surveys (10%). The contrast program was interpreted positively with a high level of general knowledge and clinical relevance. Constructive feedback centred on disseminating the technique and recommendations to improve workflow through the department.

Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

“…Numerous studies have shown the advantages of 3D assessment of the annulus compared with 2D assessment using multiple modalities, including MDCT, 3,5,6,16,20,35,36 3D-TEE, [7][8][9]11,28,37 and cardiac MRI. 16 Cross-sectional 3D-TEE annulus measurements have generally been shown to be smaller than MDCT measurements, 11,23,24,38 and a recent study demonstrated that MDCT overestimated whereas 3D-TEE underestimated in vitro phantom annulus diameters.…”

“…Accurate imaging assessment of the aortic valve annulus is critical for THV sizing. Although the traditional measurement of annular diameter has been performed on the 2-dimensional (2D) echocardiographic long-axis view (sagittal plane), 3 multiple studies have demonstrated the oval shape of the annulus, [4][5][6] with the shortest dimension typically lying in the sagittal plane. Studies across multiple modalities have also shown the advantages of 3-dimensional (3D) assessment of the annulus compared with 2D assessment.…”

“…Studies across multiple modalities have also shown the advantages of 3-dimensional (3D) assessment of the annulus compared with 2D assessment. Both echocardiography [7][8][9][10][11] and multidetector row computed tomography (MDCT) 5,6,9,[12][13][14][15][16][17][18][19] have been used for annular sizing before TAVR and have been shown to be predictive of postimplantation paravalvular aortic regurgitation. 7,8,13,18,20 Because transesophageal echocardiography (TEE) is a relatively safe procedure 21,22 that does not require iodinated contrast and can be used intraprocedurally during TAVR, it is desirable to develop reproducible and accurate 3D-TEE measurements of the aortic valve annulus.…”

Simulated Prosthesis Overlay for Patient-Specific Planning of Transcatheter Aortic Valve Implantation Procedures

“…1 Multidimensional computed tomography (MDCT) images are used for the visualization and measurement of aortic root landmarks and distances. 2,3 Despite careful planning, paravalvular leakage 4 and atrioventricular block 5 remain the most frequent complications after TAVI. In this study, a newly developed prototype planning software was used.…”

Imaging techniques in transcatheter aortic valve replacement

“…An oversized prosthesis can result in annular and/or sinotubular junction rupture or coronary artery occlusion, 41,42 whereas under sizing the valve device may result in significant perivalvular leaks and aortic insufficiency, or more catastrophically device migration and embolization. 36,40,42 Definition of the correct annular orientation and axis is complex. Shown in Figure 9 are the similarities and differences between 3-D TEE and CTA using a similar multiplanar reformation technique.…”