Aortic annulus sizing in bicuspid and tricuspid aortic valves using CT in patients with surgical aortic valve replacement

Abstract

The purpose of this study was to evaluate whether bicuspid anatomy affects the discrepancy between CT-derived annular size and intraoperative size. We retrospectively analyzed annular measurements in 667 patients who underwent surgical aortic valve replacement (AVR). Preoperative CT measurements of the aortic annulus were compared to surgically implanted valve sizes. To evaluate whether the bicuspid valve affects the differences between CT annulus diameter and surgical AVR size, patients with diameter larger by > 10% (CT-Lg group) on CT, compared to surgical AVR size, were compared with those having size difference < 10% (CT-Sim group). Propensity score matching yielded 183 matched patients from each group. Bicuspid aortic valve annulus parameters significantly correlated with surgical aortic valve size (r = 0.52–0.71; for all, p < 0.01). The most representative measurements corresponded to surgical aortic valve size were area-derived diameters in tricuspid aortic valve (r = 0.69, p < 0.001) and bicuspid without raphe (r = 0.71, p < 0.001), and perimeter-derived diameter in bicuspid with raphe (r = 0.63, p < 0.001). After propensity score matching, native valve type was not different between CT-Sim and CT-Lg groups. In multivariable analysis, the difference between CT-derived diameter and surgical AVR size was affected by the operator factor and types of prosthesis. Bicuspid aortic annulus diameters measured on CT showed a significant correlation with surgical aortic valve size. The difference between CT-derived diameter and surgical AVR size is affected by operator factor and the types of prosthesis but not affected by the bicuspid valve.

Comparing Two Methods of Aortic Annulus Computed Tomography Measurements: A Retrospective Teleradiology Saudi Study

“…In general, such annular measurements are smaller on average compared to other studies assessing the annular diameter of the aortic valve on CT. For example, in a survey by Dashkevich et al, the mean transverse diameter measured on CT was 24.5 ± 2.6 mm [7]. In another study by Choe et al, the aortic annulus mean transverse diameter was 25.6 ± 3.1 2 mm, and the area-derived diameter was 25.2 ± 3.1 [8].…”

A computational framework for post‐TAVR cardiac conduction abnormality (CCA) risk assessment in patient‐specific anatomy

“…In this study, concept presented in Mori et al 31 was adopted to identify the MS with respect to the location of the basal plane. Initially, a virtual basal plane was created by joining together the nadirs of aortic leaflets following the technique described in Choe et al 32 The proximal and the distal landmarks of the membranous septum were identified and the distance of the top and the bottom points of the MS from the basal plane were measured from coronal view 15 . Then, top and the bottom points of the MS were measured in a second plane at right angles that bisected the interleaflet triangle between the right coronary and non‐coronary leaflets.…”

Improvement in Image Quality and Visibility of Coronary Arteries, Stents, and Valve Structures on CT Angiography by Deep Learning Reconstruction

“…In addition, CTA has been recognized as a standard technique for the preoperative assessment for transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR), and transcatheter tricuspid valve replacement (TTVR) [ 2 3 ]. Aortic annular and valve sizing should be measured accurately to prevent the risk of complications after the procedure [ 4 5 ]. Therefore, the clear delineation of valves with high temporal and spatial resolution images plays an important role in pre- and postoperative evaluations.…”