Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

Aims Aortic regurgitation after transcatheter aortic valve implantation (TAVI) is one of the most frequent complications. However, the underlying mechanisms of this complication remain unclear. The present evaluation studied the anatomic and morphological features of the aortic valve annulus that ma...

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Published in:European heart journal 2010-05, Vol.31 (9), p.1114-1123
Main Authors: Delgado, Victoria, Ng, Arnold C.T., van de Veire, Nico R., van der Kley, Frank, Schuijf, Joanne D., Tops, Laurens F., de Weger, Arend, Tavilla, Giuseppe, de Roos, Albert, Kroft, Lucia J., Schalij, Martin J., Bax, Jeroen J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angioplasty, Balloon - methods
Aortic stenosis
Aortic Valve - pathology
Aortic Valve Insufficiency - diagnostic imaging
Aortic Valve Insufficiency - etiology
Aortic Valve Insufficiency - pathology
Aortic Valve Stenosis - surgery
Biological and medical sciences
Cardiology. Vascular system
Echocardiography
Endocardial and cardiac valvular diseases
Female
Heart
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - methods
Humans
Male
Medical sciences
Multi-slice computed tomography
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Tomography, X-Ray Computed - methods
Transcatheter aortic valve implantation
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Summary:Aims Aortic regurgitation after transcatheter aortic valve implantation (TAVI) is one of the most frequent complications. However, the underlying mechanisms of this complication remain unclear. The present evaluation studied the anatomic and morphological features of the aortic valve annulus that may predict aortic regurgitation after TAVI. Methods and results In 53 patients with severe aortic stenosis undergoing TAVI, multi-detector row computed tomography (MDCT) assessment of the aortic valve apparatus was performed. For aortic valve annulus sizing, two orthogonal diameters were measured (coronal and sagittal). In addition, the extent of valve calcifications was quantified. At 1-month follow-up after procedure, MDCT was repeated to evaluate and correlate the prosthesis deployment to the presence of aortic regurgitation. Successful procedure was achieved in 48 (91%) patients. At baseline, MDCT demonstrated an ellipsoid shape of the aortic valve annulus with significantly larger coronal diameter when compared with sagittal diameter (25.1 ± 2.4 vs. 22.9 ± 2.0 mm, P < 0.001). At follow-up, MDCT showed a non-circular deployment of the prosthesis in six (14%) patients. Moderate post-procedural aortic regurgitation was observed in five (11%) patients. These patients showed significantly larger aortic valve annulus (27.3 ± 1.6 vs. 24.8 ± 2.4 mm, P = 0.007) and more calcified native valves (4174 ± 1604 vs. 2444 ± 1237 HU, P = 0.005) at baseline and less favourable deployment of the prosthesis after TAVI. Conclusion Multi-detector row computed tomography enables an accurate sizing of the aortic valve annulus and constitutes a valuable imaging tool to evaluate prosthesis location and deployment after TAVI. In addition, MDCT helps to understand the underlying mechanisms of post-procedural aortic regurgitation.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehq018