MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle?

Tomas Jurencak, Jakub Turek, Bas Kietselaer, Casper Mihl, Madeleine Kok, Vincent G. V. A. van Ommen, Leen A. F. M. van Garsse, Estelle C. Nijssen, Joachim E. Wildberger, Marco Das*

*Corresponding author for this work

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Abstract

To determine the optimal imaging time point for transcatheter aortic valve implantation (TAVI) therapy planning by comprehensive evaluation of the aortic root. Multidetector-row CT (MDCT) examination with retrospective ECG gating was retrospectively performed in 64 consecutive patients referred for pre-TAVI assessment. Eighteen different parameters of the aortic root were evaluated at 11 different time points in the cardiac cycle. Time points at which maximal (or minimal) sizes were determined, and dimension differences to other time points were evaluated. Theoretical prosthesis sizing based on different measurements was compared. Largest dimensions were found between 10 and 20 % of the cardiac cycle for annular short diameter (10 %); mean diameter (10 %); effective diameter and circumference-derived diameter (20 %); distance from the annulus to right coronary artery ostium (10 %); aortic root at the left coronary artery level (20 %); aortic root at the widest portion of coronary sinuses (20 %); and right leaflet length (20 %). Prosthesis size selection differed depending on the chosen measurements in 25-75 % of cases. Significant changes in anatomical structures of the aortic root during the cardiac cycle are crucial for TAVI planning. Imaging in systole is mandatory to obtain maximal dimensions. aEuro cent Most aortic root structures undergo significant dimensional changes throughout the cardiac cycle. aEuro cent The largest dimensions of aortic parameters should be determined to optimize TAVI. aEuro cent Circumference-derived diameter showed maximum dimension at 20 % of the cardiac cycle.
Original languageEnglish
Pages (from-to)1975-1983
JournalEuropean Radiology
Volume25
Issue number7
DOIs
Publication statusPublished - Jul 2015

Keywords

  • Aortic valve
  • Aortic valve stenosis
  • Multidetector computed tomography
  • Cardiac gated imaging technique
  • Heart valve prosthesis implantation

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