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

Abstract

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.

Assessment of the Aortic Root Using Real-Time 3D Transesophageal Echocardiography

“…In contrast, Stolzmann et al reported that transverse, but not longitudinal, remodeling of the aortic root, including increased diameter of the aortic annulus and sinotubular junction, occurs in patients with severe AS. 20 Although further studies are needed to resolve these conflicting results, the wide intersubject variability and reduced distance to the coronary arteries raises the importance of these measurements before TAVI. Our results suggest that 3DTEE may be a potential alternative to MDCT for assessing aortic root geometry.…”

Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode

“…For a successful TAVI procedure, certain anatomic criteria must be met to facilitate valve delivery and placement. Due to the large inter-individual differences concerning the location of the coronary ostia and the dilatation of the aortic root in patients with aortic stenosis, pre-procedural cardiac CT seems advisable [15]. Injury to the femoral or iliac arteries during valve delivery via a large introducer sheath is of major concern, consequently patient selection is critical.…”

High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

“…Accurate knowledge of the anatomy of the aortic valveaortic root complex as well as precisely locating the coronary ostia is critical for a number of interventional and surgical cardiovascular procedures, including cannulation or catheterization of the coronary arteries, aortic graft repair or root replacement, and implantation of aortic valves using minimal invasive surgical or interventional techniques [1]. In addition, detailed visualization of the anatomy is mandatory for demonstrating the extent of aortic disease involving the aortic root, such as type A aortic dissection or annulo-aortic ectasia and aortic aneurysms.…”