CT measurements of aortic annulus in patients who underwent TAVI: differences between systolic and diastolic phase.

Transcription

1 CT measurements of aortic annulus in patients who underwent TAVI: differences between systolic and diastolic phase. Poster No.: C-0523 Congress: ECR 2014 Type: Scientific Exhibit Authors: A. Vallone, V. BUFFA, S. Fierro, M. Luzietti, G. L. Buquicchio, M. Madau, V. Miele; Roma (RM)/IT Keywords: Cardiac Assist Devices, Computer Applications-3D, CTAngiography, Cardiac DOI: /ecr2014/C-0523 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Aims and objectives The aim of our study is to evaluate wether there are significant differences in Computed Tomography (CT) measurements of aortic annulus between systolic and diastolic phase in patients who underwent Transcatheter Aortic Valve Implantation (TAVI). Aortic annular size is conventionally measured at end-systole using echocardiography. Accurate preoperative assessment of the aortic annulus is important because of complications like annular rupture, coronary arteries obstruction, prosthesis migration or paravalvular leakage. Methods and materials 96 patients (n=96) who underwent implantation of aortic prosthetic valve with TAVI technique, were studied with MDCT in the period comprised from January 2011 to August All scans were performed with a dual-source 64-row CT (Somatom Definition, Siemens, Germany) with retrospective ECG-gating. With a dual-head CT injiector (Medrad, Bayer Healt Care, Leverkusen, Germany) a first intravenous administration of 90 ml of non-ionic iodinated contrast medium (Iomeron 400 mg/ml, Bracco, Milan, Italy) was provided at a flow rate of 4 ml/s, followed by a second administration of 40 ml of the same non-ionic iodinated contrast medium provided at a flow rate of 3 ml/s and by 50 ml saline flush at a flow rate of 3 ml/s. The CT scan began by bolus tracking in ascending aorta (100 Hounsfield Units) and was performed in the cranio-caudal direction. Images were reconstructed into various cardiac phases (10-90% RR interval) and we choose the best qualitatively phase both in systole (25-47% RR interval) and diastole (65-86% RR interval). Measurements were performed on a commercially available medical workstation (Circulation, Syngo, Siemens, Berlin and Munchen, Germany). Parameters evaluated were diameters (shortest and longest), circumference and area of aortic annulus both in systolic and diastolic phase. We also evaluated the height of coronary ostia (annulus to right and left coronary ostia distance) in both cardiac cycle phases. Measuments of the height of coronary ostia were performedin the modified coronal and sagittal views (fig. 1; fig. 2); aortic annulus size was measured in the basal ring plane (fig. 3; fig. 4; fig. 5). Prosthesis utilized were Corevalve and Edwards. Patients were retrospectively reviewed by 3 radiologists, each of which compiled in cieco a table for each patient reporting measuerements of aortic annulus and height of coronary ostia in systolic and diastolic phase, indicating the type of the implanted prosthesis. All the tables were compared for evaluation of interobserver agreement in the choice of the prosthesis to be implanted. We also assessed the absence of adverse events at one year after surgery. Page 2 of 8

3 Fig. 1: Measuments of the height of right coronary ostia Page 3 of 8

4 Fig. 2: Measuments of the height of left coronary ostia Page 4 of 8

5 Fig. 3: Measuments of shortest and longest diameters of aortic annulus Page 5 of 8

6 Fig. 4: Mesurements of circumference of aortic annulus Page 6 of 8

7 Fig. 5: Mesurements of area of aortic annulus Results There were no statistically significant differences in interobserver assessment of the prosthesis to be implanted. Measurements of aortic annulus and height of coronary ostia documented differences of a few millimeters between systole and diastole. These Page 7 of 8

8 differences were more evident in assessment of diameter and height of coronary ostia and less evident in evaluation of area and circumference, but did not change the decision on the type of prosthesis to be implanted. Conclusion By comparing the size of aortic annulus between systolic and diastolic phase small differences were observed. Anyway these differences had no impact on the choice of the type of prosthesis to be implanted. Personal information References Cerillo AG, Mariani M, Berti S, Glauber M. Sizing the aortic annulus. Ann Cardiothorac Surg 2012;1(2): doi: / j.issn x Bertaso AG, Wong DT, Liew GY, Cunnington MS, Richardson JD, Thomson VS, et al (2012) Aortic annulus dimension assessment by computed tomography for transcatheter aortic valve implantation: differences between systole and diastole. Int J Cardiovasc Imaging. doi / s Page 8 of 8