The interaction of de novo and pre-existing aortic regurgitation after TAVI: insights from a new quantitative aortographic technique

Abstract

AR after TAVI could be quantitated utilising LVOT-AR. The cut-point of >0.17 indicates a significant AR pertaining to increased intermediate-term mortality, especially in those with no significant pre-existing AR.

Role of Computed Tomography in Planning the Appropriate X-Ray Gantry for Quantitative Aortography of Post-transcatheter Aortic Valve Implantation Regurgitation

“…Theoretically, LVOT-AR ranges from 0 to 1 (Figure 3). [2][3][4][5][6][7] Furthermore, the reproducibility of this VD method was evaluated by 2 local trained observers at Yamaguchi University Hospital and by core laboratory staff at an independent core frames are recorded -software required; (2) the contrast enhancement-dynamic mode is inactivated; (3) during image acquisition, the patient and the table of the cath-lab are kept immobile; (4) the tip of the pigtail catheter is located just above the leaflet coaptation level to avoid the interference of the catheter with the valve leaflets (Table; Figure 1); and (5) after identification of the optimal implanter view, in which the nadirs of 3 coronary cusps are aligned, using a dedicated software (3 mensio Valve version 8.0, 3 mensio Medical Imaging BV, Bilthoven, Netherlands), the optimal angiographic view for VD analysis is identified, in order to avoid the overlap of background structures with the ROI (sub-aortic segment designed by the basal third of the LV on fluoroscopy) and to minimize LVOT foreshortening on MSCT. Figure 2 shows examples of volume rendering images reconstructed using the dedicated software (3 mensio Valve version 8.0; 3 mensio Medical Imaging BV, Bilthoven, Netherlands; Figure 2A,A',D,D'), 2-D virtual "fluoroscopic" view derived from MSCT ( Figure 2B,B',E,E') and aortograms ( Figure 2C,C',F,F').…”

“…2 Over the past 2 years, the precision and accuracy of the method have been validated in vitro, compared clinically with other methods of assessment such as echocardiography and magnetic resonance imaging (MRI), and evaluated from a prognostic point of view. [2][3][4][5][6][7] This technology could overcome the I n the minimalist transcatheter aortic valve implantation (TAVI) era, the use of echocardiography, the traditional tool to evaluate the severity of aortic regurgitation (AR) during TAVI, has become restricted, while the importance of aortography as a diagnostic tool to evaluate the severity of AR is increasing. Using dedicated contrastvideodensitometry (VD) software, Schultz et al reported an objective and reproducible method to assess the severity of AR after TAVI.…”

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

“…Although the difference in mortality was not significant (log rank p = 0.273) in this small population with BPD, a tendency for high mortality was previously reported in patients with VD-AR > 17% in a large population. 14 , 16 …”

“…VD-AR was performed and found to be analysable in 228 patients. 16 In this population, 102 patients underwent BPD, and in 17 cases, no angiography was available before BPD. Out of 85 cases with available aortograms before and after BPD, VD-AR was analysable at both time points in 61 cases (Figure 1).…”

“…The details of this technique have been described elsewhere. 12 - 14 , 16 , 18 After drawing the contours of the aortic root ( i.e . reference region) and the subaortic one third of the left ventricle (i.e.…”