Value of cardiac CT in comprehensive aortic valve and root evaluation before percutaneous aortic valve replacement

Abstract

Background

Aortic stenosis (AS) is the most frequent valvular heart disease, and patients who develop AS are at a high risk of sudden death. There is no medical cure available, and aortic valve replacement is the only effective treatment for advanced disease. Preoperative evaluation is the cornerstone of therapy and is necessary for selecting the implantation technique and valve.

Purpose

To evaluate the role of cardiac CT in comprehensive aortic valve and aortic root evaluation before percutaneous aortic valve replacement.

Material and Methods

Thirty-four patients with severe aortic valve stenosis were evaluated by cardiac CT. The aortic valve calcification grade defined by cardiac CT was compared to the operative findings. The mean calculated aortic annulus diameter (CAAD) measured by cardiac CT was compared to the aortic annulus diameter measured by transthoracic echocardiography (TTE) as well as during the operation. The distances from the aortic valve annulus to the coronary ostia (right and left) were measured by cardiac CT and compared to the intraoperative measurements. The findings from the CT coronary angiography and conventional coronary angiography were compared.

Results

There was strong agreement (k = 0.865) between the calcification grade by cardiac CT and the intraoperative grading. There was a stronger correlation (r = 0.948) between the CAAD assessed by cardiac CT and intraoperatively compared to the correlation between the intraoperative versus TTE measurements (r = 0.660). The distances measured between the aortic annulus and the right and left coronary artery ostia by cardiac CT were strongly correlated with the distances measured intraoperatively (r = 0.966 and 0.940 in the right and left sides, respectively). Cardiac CT detected three coronary artery stenotic lesions and three patent stents. All findings were confirmed by conventional coronary angiography. Thirteen percent of the evaluated coronary artery segments were of non-diagnostic quality by cardiac CT.

Conclusion

Cardiac CT substantially facilitates the assessment of aortic root morphology prior to aortic valve replacement.

Keywords

Cardiac CT angiography valves

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References

Lindroos

, Kupari

, Heikkila

, Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;2:1220–5

Iung

, Baron

, Butchart

, A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 2003;24:1231–43

Goldbarg

, Elmariah

, Miller

, Insights into degenerative aortic valve disease. J Am Coll Cardiol 2007;50:1205–13

Schoenhagen

, Tuzcu

, Kapadia

, Three-dimensional imaging of the aortic valve and aortic root with computed tomography: new standards in an era of transcatheter valve repair/implantation. Eur Heart J 2009;30:2079–86

McCollough , Cody , Edyvean

, ; American Association of Physicists in Medicine (AAPM). The Measurement, Reporting, and Management of Radiation Dose in CT. Report of AAPM Task Group 23 of the Diagnostic Imaging Council CT Committee . College Park, MD: SAGE Publications, 2008

Nishi

, Mitsuno

, Ryomoto

, Comprehensive approach for clamping severly calcified ascending aorta using computed tomography. Interact CardioVasc Thorac Surg 2010;10:18–20

Lee

, Matsutani

, Polimenakos

, Preoperative noncontrast chest computed tomography identifies potential aortic emboli. Ann Thorac Surg 2007;84:38–42

Willmann

, Weishaupt

, Lachat

, Electrocardiographically-gated multi-detector row CT for assessment of valvular morphology and calcificationin aortic stenosis. Radiology 2002;225:120–8

Lung

, Cachier

, Baron

, Decision-making in elderly patients with severe aortic stenosis. Eur Heart J 2005;26:2714–20

10.

Van Geldorp

MWA

, Van Gameren

, Kappetein

Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?

Eur J Cardiothorac Surg 2009;35:953–7

11.

Vahanian

, Alfieri

, At-Attar

, Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2008;34:1–8

12.

Descoutures

, Himbert

, Lepage

, Contemporary surgical or percutaneous management of severe aortic stenosis in elderly. Eur Heart J 2008;29:1410–7

13.

Walther

. Transapical aortic valve implantation: step by step. Ann Thorac Surg 2009; 87:276–83

14.

Dashkevich

, Blanke

, Siepe

, Preoperative assessment of aortic annulus dimensions: comparing of non-invasive and intraoperative measurements. Ann Thorac Surg 2011;91:709–15

15.

Messika-Zeitoun

, Serfaty

, Brochet

Multimodal assessment of the aortic annulus diameter, implications for transcatheter aortic valve replacement

. J Am Cardiol 2010;55:186–94

16.

Kempfert

, Van-Linden

, Lehmkuhl

, Aortic annulus sizing: echocardiography vs. computed tomography derived measurements in comparison with direct surgical sizing. Eur J Cardiothorac Surg 2012;42:627–33

17.

Buzzatti

, Maisano

, Latib

, Computed tomography-based evaluation of aortic annulus, prosthesis size and impact on early residual aortic regurgitation after transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2013;43:43–51

18.

Blanke

, Siepe

, Reinohl

, Assessment of aortic annulus dimensions for Edwards SAPIEN transapical heart valve implantation by computed tomography: calculating average diaeter using a virtual ring method. Eur J Cardiothorac Surg 2010;38:750–8

19.

Lang

, Bierig

, Devereux

, Recommendations for chamber quantification: a report from the American Society of Cardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440–63

20.

Akhtar

, Tuzcu

, Kapadia

, Aortic root morphology in patients undergoing percutaneous aortic valve replacement: evidence of aortic root remodeling. J Thorac Cardiovasc Surg 2009;137:950–6