Aortic Stenosis: Comparative Evaluation of 16–Detector Row CT and Echocardiography

Alkadhi, Hatem; Wildermuth, Simon; Plass, André; Béttex, Dominique; Baumert, Bernhard; Leschka, Sebastian; Desbiolles, Lotus; Marinček, Borut; Boehm, Thomas

doi:10.1148/radiol.2393050458

Cited by 107 publications

(42 citation statements)

References 31 publications

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“…CT may be performed and is useful to confirm AS severity and to define valve anatomy [25][26][27]. This study provides data of coronary ostia locations and aortic root dimensions in patients with severe tricuspid AS and demonstrates differences in these patients when compared with the controls.…”

Section: Discussionmentioning

confidence: 82%

“…This selection bias, however, is generated by the fact that AS generally occurs in the elderly population. Third, results from TTE in the assessment of AS were not compared with results from CT, but has been amply documented in the literature [25,26,35,36]. Finally, the impact of the preprocedural anatomical assessment on patient outcome was not assessed in the present study.…”

Section: Limitationsmentioning

confidence: 97%

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Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

et al. 2009

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Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation Abstract Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dualsource CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9±3.2 mm (8.2-25.9) and 16.8±3.6 mm (12.0-25.7) in the controls, 15.5±2.9 mm (8.8-24.3) and 17.3±3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P= 0.18), RCO (P=0.33) and HLS (P= 0.88), whereas HRS (P<0.05) was significantly larger in patients with AS. AA (r=0.55,P<0.001), SV (r= 0.54,P<0.001), and STJ (r=0.52,P< 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P<0.01) and STJ (P<0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient.

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Section: Discussionmentioning

confidence: 82%

Section: Limitationsmentioning

confidence: 97%

Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

et al. 2009

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“…For diagnosis of AI, TTE, TEE, angiography or MRI can be applied. Non-invasive assessment for both AS and AI is also possible with CT [16,17].…”

Section: Patient Selectionmentioning

confidence: 99%

Transcatheter aortic valve implantation. Role of imaging

Gessat

Frauenfelder

Altwegg

et al. 2011

Aswan Heart Centre Science &Amp; Practice Series

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Transcatheter aortic valve implantation (T-AVI) has shown good results in high-risk patients with severe aortic stenosis. Throughout the whole process of T-AVI, different imaging modalities are indispensable. Preoperatively, multislice computed tomography, angiography and transesophageal echo (TEE) are utilized for patient selection, valve selection, approach selection and the planning of implant placement. Intraoperatively, angiography and TEE are used for controlling placement of the guidewire and valve positioning. Quality control and follow-up require TEE imaging and can require additional CT or angiography studies. In the first half of this paper, we discuss the applicability of different imaging modalities for T-AVI in the light of the current best practice. In the second half of this paper, we present an overview on research projects in medical engineering which aim at development of imagebased methods for increasing patient safety during T-AVI. Template-based implantation planning, as it is applied in dental, orthopedic and other surgical disciplines, is proposed as an aid during implant selection in order to help reduce the incidence of complications such as atrioventricular node block and paravalvular leaks. Current research tries to apply state-of-the-art engineering techniques, such as computational fluid dynamics to optimize valve selection and positioning. For intraoperative assistance during valve positioning, real-time image processing methods are proposed to track target landmarks and the stented valve. ABSTRACTTranscatheter aortic valve implantation (T-AVI) has shown good results in high-risk patients with severe aortic stenosis. Throughout the whole process of T-AVI, different imaging modalities are indispensable. Preoperatively, multislice computed tomography, angiography and transesophageal echo (TEE) are utilized for patient selection, valve selection, approach selection and the planning of implant placement. Intraoperatively, angiography and TEE are used for controlling placement of the guidewire and valve positioning. Quality control and follow-up require TEE imaging and can require additional CT or angiography studies. In the first half of this paper, we discuss the applicability of different imaging modalities for T-AVI in the light of the current best practice.In the second half of this paper, we present an overview on research projects in medical engineering which aim at development of image-based methods for increasing patient safety during T-AVI. Template-based implantation planning, as it is applied in dental, orthopedic and other surgical disciplines, is proposed as an aid during implant selection in order to help reduce the incidence of complications such as atrioventricular node block and paravalvular leaks. Current research tries to apply state-of-the-art engineering techniques, such as computational fluid dynamics to optimize valve selection and positioning. For intraoperative assistance during valve positioning, real-time image processing methods are proposed to t...

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“…During the remaining part of the cardiac cycle, the tube output was reduced. When employed for coronary CT angiography, this technique has been shown to achieve an overall ionizing radiation exposure savings of 30-50% (10,11) have shown that MDCT can be used for anatomic delineation of the aortic valve area by performing MPR of axial images using a 16-channel ECGgated CTA during coronary imaging. We used 75% of the R-R interval to generate MPR using 64-channel MDCT during CTA of the aorta.…”

Section: Image Acquisitionmentioning

confidence: 99%

Prevelance of aortic root dilation in patients with cta of the aorta

Ocak

Lacomis

Deible

et al. 2010

Diagn Interv Radiol

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272T horacic aortic aneurysm (TAA) is a potentially life-threatening disorder if not diagnosed before the development of dissection and rupture. TAA is defined as a localized dilation of the aorta to more than 50% of baseline. The incidence of TAA is estimated at 6 people per 100,000 per year, and the mean age at diagnosis is 60-70 years. (1). Of all patients presenting with TAA, 60% involve the aortic root and/or ascending aorta (2). The aortic root is described as the part of the aorta that supports the aortic valve leaflets, delineated superiorly by the sinotubular junction (STJ) and inferiorly by the annulus (3). Determination of the segment, or segments involved in the dilation has clinical and surgical significance.Multi-detector row computed tomography (MDCT) is an emerging noninvasive tool for the accurate detection and segmentation of TAA. The current generations of 64-slice scanners, with submillimeter slice collimation and high temporal resolution, have improved our ability to identify and localize TAA. Retrospective electrocardiographically (ECG)-gated MDCT has enabled high quality multiplanar reformation (MPR) and volume-rendered (VR) images. Thus, visualization of the extension of the aneurysm as well as estimation of diameter of the aortic annulus, sinuses of valsalva and sinotubular junction are possible.Although there have been extensive studies on measurements of the aortic valve with MDCT, little imaging information is available on the rate of dilation of the different aortic segments and aortic root structures (4, 5). Recently, Lu et al. (6) reported normal measurements of the ascending aorta (the mean diameters of the coronary sinus, sinotubular junction and ascending aorta were 34.2 mm, 29.7 mm and 32.7 mm, respectively) in 78 patients with MDCT. Accordingly, the present study was undertaken to explore the physical dimensions of the aortic root and its structures at the level of the sinuses of valsalva, annulus, sinotubular junction, and AAo with MPR in a patient population scanned for CTA of the aorta. Materials and methods SubjectsThe patient population participating in this retrospective study was comprised of individuals who had been scanned for thoracic aortic aneurysm and/or dissection at our institution between December 2005 and January 2007. The study was approved by the institutional committee on human research. An honest broker prepared and presented all CT images and medical information in a coded, unidentified manner; the investigators were privy only to the age and sex of individual patients. The data were retrospectively reviewed to exclude all patients documented with coexistent proximal aortic pathology or surgery. Patients with Marfan syndrome, bicuspid aortic valve, or a history of prior MATERIALS AND METHODSIn 95 patients, 64-slice multislice computed tomography was performed for evaluation of the thoracic aorta. Measurements of the annulus, sinuses of valsalva (SOV), sinotubular junction (STJ), and maximum ascending aorta (AAo) were made by double oblique multiplanar re...

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Aortic Stenosis: Comparative Evaluation of 16–Detector Row CT and Echocardiography

Abstract: Planimetric measurements of AVA with retrospectively electrocardiographically gated 16-detector row CT allow classification of AS that is similar to that achieved with measurements by using echocardiographic methods.

Cited by 107 publications

References 31 publications

Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

Transcatheter aortic valve implantation. Role of imaging

Prevelance of aortic root dilation in patients with cta of the aorta

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