BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for high-risk and inoperable patients. Advanced multimodality imaging, including computed tomography (CT), plays a key role for optimized planning of TAVI. METHODS: Forty-nine patients (25 women; age, 82.3±8.8 year) with severe aortic stenosis scheduled for TAVI were examined with 128-slice high-pitch dual-source prospective aortoiliac CT angiography (CTA). The 3-coronary-sinus-alignment (3-CSA) plane, comprising left and right anterior oblique and craniocaudal projection, was defined from three-dimensional volume-rendered technique data sets and compared with the intraoperative angiographic plane (deployment plane) used for device implantation. A tolerance level of ±5-degree deviation was acceptable. Volume of intraoperative iodine contrast agent was compared before and after the implementation of the 3-CSA plane estimation by CT. RESULTS: All 49 patients underwent TAVI, during which 6 CoreValves (Medtronic, Minneapolis, MN) and 43 Sapien valves (Edwards Lifesciences, Irvine, CA) were successfully implanted using transapical (n=29), transfemoral (n=17), and transaxillary access (n=4). No severe complications occurred. In 47 patients (96%), CTA correctly predicted the 3-CSA plane used for device implantation. Mean left anterior oblique by CTA was 5.3±6.5 degrees and craniocaudal was -1.3±10.1 degrees. Mean left anterior oblique deviation between CTA and the intraoperative projection was 2.1±2.7 degrees and craniocaudal was 1.7±3.0 degrees. Ostium heights of the right and left coronary arteries were 12±1.9 and 12.9±3.3 mm. No over-stenting occurred in left coronary artery ostia of 8 mm or more. Contrast volume was reduced from 81.8±25.6 to 59.4±40.2 mL (p=0.05) when using 3-CSA plane estimation by CT for final prosthesis implantation plane. CONCLUSIONS: Aortoiliac high-pitch 128-slice dual-source CT contributes to TAVI planning, including reliable prediction of the 3-CSA valve deployment plane, which saves contrast volume during the procedure and may facilitate correct valve placement.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for high-risk and inoperable patients. Advanced multimodality imaging, including computed tomography (CT), plays a key role for optimized planning of TAVI. METHODS: Forty-nine patients (25 women; age, 82.3±8.8 year) with severe aortic stenosis scheduled for TAVI were examined with 128-slice high-pitch dual-source prospective aortoiliac CT angiography (CTA). The 3-coronary-sinus-alignment (3-CSA) plane, comprising left and right anterior oblique and craniocaudal projection, was defined from three-dimensional volume-rendered technique data sets and compared with the intraoperative angiographic plane (deployment plane) used for device implantation. A tolerance level of ±5-degree deviation was acceptable. Volume of intraoperative iodine contrast agent was compared before and after the implementation of the 3-CSA plane estimation by CT. RESULTS: All 49 patients underwent TAVI, during which 6 CoreValves (Medtronic, Minneapolis, MN) and 43 Sapien valves (Edwards Lifesciences, Irvine, CA) were successfully implanted using transapical (n=29), transfemoral (n=17), and transaxillary access (n=4). No severe complications occurred. In 47 patients (96%), CTA correctly predicted the 3-CSA plane used for device implantation. Mean left anterior oblique by CTA was 5.3±6.5 degrees and craniocaudal was -1.3±10.1 degrees. Mean left anterior oblique deviation between CTA and the intraoperative projection was 2.1±2.7 degrees and craniocaudal was 1.7±3.0 degrees. Ostium heights of the right and left coronary arteries were 12±1.9 and 12.9±3.3 mm. No over-stenting occurred in left coronary artery ostia of 8 mm or more. Contrast volume was reduced from 81.8±25.6 to 59.4±40.2 mL (p=0.05) when using 3-CSA plane estimation by CT for final prosthesis implantation plane. CONCLUSIONS: Aortoiliac high-pitch 128-slice dual-source CT contributes to TAVI planning, including reliable prediction of the 3-CSA valve deployment plane, which saves contrast volume during the procedure and may facilitate correct valve placement.
Authors: Bernhard Bischoff; Felix G Meinel; Maximilian Reiser; Hans-Christoph Becker Journal: Int J Cardiovasc Imaging Date: 2013-01-19 Impact factor: 2.357
Authors: Tomas Jurencak; Jakub Turek; Bastiaan L J H 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 Journal: Eur Radiol Date: 2015-02-24 Impact factor: 5.315
Authors: Barbora Horehledova; Casper Mihl; Ellen Boswijk; Genevieve A J C Crombag; Estelle C Nijssen; Patty J Nelemans; Leo F Veenstra; Joachim E Wildberger; Marco Das Journal: PLoS One Date: 2020-05-12 Impact factor: 3.240