Utility of CT Angiography for the Prediction of Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Replacement

Abstract

Objectives: We aimed to evaluate the utility of computed tomography angiography (CTA) for coronary compression (CC) prediction in patients with congenital heart disease undergoing balloon-expandable transcatheter pulmonary valve replacement (TPVR). Background: Coronary compression is a serious complication of TPVR, but the value of preprocedural CTAs to assess CC risk is largely unexplored. Methods: In all, 586 patients underwent TPVR between January 2009 and July 2018. Adults with a pre-TPVR CTA and children with a CTA performed less than one year prior to TPVR were included. Patients with poor CTA image quality or with aborted cases due to reasons other than CC were excluded. Sixty-six patients were finally included. Cardiac anatomy was assessed via multiplanar reconstruction of CTAs. Results: Coronary compression occurred in 9 (14%) of the 66 patients who underwent TPVR. Most CC cases (seven of nine) occurred in patients with conduits. Proximity of the right ventricular outflow tract (RVOT) landing zone to the coronary arteries and to the chest wall was a significant risk factor for compression ( P < .001 and P = .019, respectively). Compression risk increased significantly if patients had an RVOT to coronary artery distance of ≤3 mm ( P < .001) and an RVOT to chest wall distance of ≤8 mm ( P = .026). Anomalous course of coronary arteries was another significant univariate risk factor ( P = .003). Conclusions: Right ventricular outflow tract landing zone distance of ≤3 mm to a coronary artery, landing zone distance of ≤8 mm to the chest wall, and anomalous coronary arteries are associated with increased CC risk. Electrocardiogram gating may not be necessary if coronary arteries are opacified on CTAs. Larger studies are needed to explore and confirm these coronary artery compression risk factors.

Coronary Artery Anomalies and Their Impact on the Feasibility of Percutaneous Pulmonary Valve Implantation

“…Abnormal coronary artery anatomy was demonstrated in 34/226 (15%) patients with tetralogy of Fallot who underwent catheterization and testing for intended PPVI [ 7 ]. In this and in other studies coronary artery anomalies were associated with an increased risk of coronary artery compression during balloon interrogation of the RVOT [ 5 , 7 , 16 ]. Despite this statistically increased risk the results of our study show that successful PPVI is possible in the majority of patients exhibiting a major coronary artery branch crossing the RVOT.…”

“…Although the majority of the patients in our study had preceding 3D imaging for evaluation of the anatomy of the RVOT and coronary arteries the final decision for valve implantation was based on the results of angiographic imaging of the RVOT, balloon interrogation of the landing zone, and simultaneous imaging of the coronary arteries. Based on continuous improvements of 3D imaging techniques and introduction of image fusion techniques it can be expected that evaluation of the landing zone and its proximity to coronary artery branches will become even more accurate providing the possibility of exact pre-interventional planning and optimal deployment of the valve [16,[22][23][24][25][26][27][28].…”

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion

“…Although MRI has high temporal resolution and soft tissue resolution, it has poor effect on coronary artery imaging due to the thin diameter of coronary artery, tortuous shape, and more adipose tissue in adjacent parts [ 11 , 12 ]. CT can measure the human body with highly sensitive instruments according to the different X-ray absorption and transmittance of different human tissues and show the small lesions in any part of the body [ 13 ]. Coronary computed tomography angiography (CCTA) has become an important method for early diagnosis of coronary heart disease as a rapid noninvasive imaging method developed in the past decade.…”

Stent angioplasty for coronary compression syndrome related to prosthetic aortic valve

“…The risk of coronary compression is particularly reconsidered before transcatheter pulmonary valve implantation and represents the major contra-indication. 1 , 2 Data from the literature have identified the anomalous course of coronary arteries as independent risk factor. 2 The appropriate management of coronary compression syndrome is not well defined but establishment of normal blood flow is the main purpose.…”

“… 1 , 2 Data from the literature have identified the anomalous course of coronary arteries as independent risk factor. 2 The appropriate management of coronary compression syndrome is not well defined but establishment of normal blood flow is the main purpose. Herein, we report on the feasibility of PCI despite the technical challenges and risk of restenosis (11%), 3 especially in high-surgical-risk patients.…”