CT in Transcatheter-delivered Treatment of Valvular Heart Disease

Rudziński, Paweł; Leipsic, Jonathan; Schoepf, U. Joseph; Dudek, Dariusz; Schwarz, Florian; Andreas, Martin; Złahoda-Huzior, Adriana; Thilo, Christian; Renker, Matthias; Burt, Jeremy R.; Emrich, Tilman; Varga-Szemes, Ákos; Amoroso, Nicholas; Steinberg, Daniel; Pukacki, Piotr; Demkow, Marcin; Kępka, Cezary; Bayer, Richard R.

doi:10.1148/radiol.210567

Cited by 18 publications

(18 citation statements)

References 99 publications

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“…Despite ongoing efforts for developing dedicated TMVR devices and distinct implantation techniques, along with reliable pre-procedural imaging, 8 , 9 LVOT-O remains a major exclusion criterion in native TMVR. 10 In recent clinical trials, around 50% of patients were excluded based on LVOT-O and/or anatomical considerations.…”

Section: Discussionmentioning

confidence: 99%

Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report

de Manna,

Martens,

Jüttner

et al. 2024

European Heart Journal - Case Reports

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Background The introduction of a transapical transcatheter beating-heart replacement system has significantly expanded therapeutic options for patients with severely diseased mitral valves (MV), particularly those ineligibles for traditional surgery or transcatheter repair. However, challenges, such as left ventricular outflow tract obstruction (LVOT-O) and the risk of dynamic systolic anterior motion (SAM) in cases with elongated anterior mitral leaflet (AML) post-prosthesis implantation, impede the widespread adoption of Transcatheter Mitral Valve Replacement (TMVR). Case Summary In 2022, a 75-year-old male with severe mixed-genesis mitral regurgitation (MR) underwent Carillon Mitral Contour System annuloplasty. Recurrent heart failure admissions (NYHA IV) and prohibitive risk for open-heart surgery (EuroSCORE II 8.27%) prompted evaluation for Tendyne TMVR with the MitraCut technique. This beating-heart transapical approach involved scissor-mediated splitting of the elongated 27mm AML, essential for mitigating LVOT-O risk and dynamic SAM. The screening echocardiogram revealed the poorly tethered AML near the thickened septum at the simulated neo-Left Ventricular Outflow Tract (neo-LVOT) site. Discussion This case underscores the intricate management challenges associated with severe MR, highlighting the successful application of the MitraCut technique as a viable alternative in high-risk scenarios. The imperative for further research and clinical studies is emphasized to comprehensively elucidate outcomes and safety parameters, providing valuable insights for refining TMVR applications within this context.

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Section: Discussionmentioning

confidence: 99%

Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report

de Manna,

Martens,

Jüttner

et al. 2024

European Heart Journal - Case Reports

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“…Cardiovascular imaging techniques are widely used and indispensable for the diagnosis and treatment of valvular heart disease. 13 Thus, dextrocardia is not difficult to diagnose clinically, and it is easy to identify such patients with CT and X-ray examinations. CT plays an important role in preoperative planning 13 because dextrocardia may be associated with an additional risk of cardiovascular abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve repair in patients with mirror-image dextrocardia and situs inversus: two cases and a review of the literature

Nie,

Tang,

Wang

et al. 2023

J Int Med Res

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Dextrocardia is a rare cardiac malposition that was first described in 1606. Mirror-image dextrocardia is characterized by a mirror-image change of the normal position of the heart. Most cases are accompanied by situs inversus viscerum, whereas only 3% to 10% of cases are associated with intracardiac anomalies. Valve surgery for acquired valvular lesions in patients with mirror-image dextrocardia with situs inversus is rare. Diagnosing situs anomalies in adults is important to prevent errors during surgical operations, emergency procedures, or interventional operations. In this report, we present two cases of mitral regurgitation in patients with mirror-image dextrocardia. One patient had mirror-image dextrocardia with subacute infective endocarditis and mitral regurgitation, and the other patient had mirror-image dextrocardia with mitral Carpentier type I regurgitation. In both patients, mitral valve repair was successfully performed using a transseptal approach.

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“…There is also growing evidence of its beneficial use in patients at intermediate or low-surgical risk [ 5 , 6 ]. The preprocedural planning for TAVR relies heavily on Electrocardiogram (ECG)-synchronized CT-angiography (CTA), which provides exact aortic annular sizing and the ideal access route evaluation [ 7 ], and can be used for post-procedural risk stratification [ 8 ]. Given the dynamic changes that the aortic annulus undergoes during the cardiac cycle, manufacturers base their heart valve sizing recommendations on systolic measurements, as this is when the annulus typically reaches its largest dimension [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Photon-counting CT-angiography in pre-TAVR aortic annulus assessment: effects of retrospective vs. prospective ECG-synchronization on prosthesis valve selection

Hagar,

Kluemper,

Hein

et al. 2024

Int J Cardiovasc Imaging

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To compare the diagnostic value of ultrahigh-resolution CT-angiography (UHR-CTA) compared with high-pitch spiral CTA (HPS-CTA) using a first-generation, dual-source photon-counting CT (PCD-CT) scanner for preprocedural planning of transcatheter aortic valve replacement (TAVR). Clinically referred patients with severe aortic valve stenosis underwent both, retrospective ECG-gated cardiac UHR-CTA (collimation: 120 × 0.2 mm) and prospective ECG-triggered aortoiliac HPS-CTA (collimation: 144 × 0.4 mm, full spectral capabilities) for TAVR planning from August 2022 to March 2023. Radiation dose was extracted from the CT reports, and the effective dose was calculated. Two radiologists analyzed UHR-CTA and HPS-CTA datasets, assessing the image quality of the aortic annulus, with regard to the lumen visibility and margin delineation using a 4-point visual-grading scale (ranges: 4 = ”excellent” to 1 = ”poor”). Aortic annulus area (AAA) measurements were taken for valve prosthesis sizing, with retrospective UHR-CTA serving as reference standard. A total of 64 patients were included (mean age, 81 years ± 7 SD; 28 women) in this retrospective study. HPS-CTA showed a lower radiation dose, 4.1 mSv vs. 12.6 mSv (p < 0.001). UHR-CTA demonstrated higher image quality to HPS-CTA (median score, 4 [IQR, 3–4] vs. 3 [IQR, 2–3]; p < 0.001). Quantitative assessments of AAA from both CTA datasets were strongly positively correlated (mean 477.4 ± 91.1 mm2 on UHR-CTA and mean 476.5 ± 90.4 mm2 on HPS-CTA, Pearson r2 = 0.857, p < 0.001) with a mean error of 22.3 ± 24.6 mm2 and resulted in identical valve prosthesis sizing in the majority of patients (91%). Patients with lower image quality on HPS-CTA (score value 1 or 2, n = 28) were more likely to receive different sizing recommendations (82%). Both UHR-CTA and HPS-CTA acquisitions using photon-counting CT technology provided reliable aortic annular assessments for TAVR planning. While UHR-CTA offers superior image quality, HPS-CTA is associated with lower radiation exposure. However, severely impaired image quality on HPS-CTA may impact on prosthesis sizing, suggesting that immediate post-scan image evaluations may require complementary UHR-CTA scanning.

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CT in Transcatheter-delivered Treatment of Valvular Heart Disease

Cited by 18 publications

References 99 publications

Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report

Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report

Mitral valve repair in patients with mirror-image dextrocardia and situs inversus: two cases and a review of the literature

Photon-counting CT-angiography in pre-TAVR aortic annulus assessment: effects of retrospective vs. prospective ECG-synchronization on prosthesis valve selection

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