Philipp Blanke1, Jong K Park2, Paul Grayburn3, Christopher Naoum2, Kevin Ong2, Keshav Kohli4, Bjarne L Norgaard5, John G Webb2, Jeffrey Popma6, David Boshell7, Paul Sorajja8, David Muller7, Jonathon Leipsic2. 1. St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. Electronic address: phil.blanke@gmail.com. 2. St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 3. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, United States. 4. Tendyne Holdings, Roseville, MN, United States. 5. Skejby University Hospital, Aarhus, Denmark. 6. Beth Israel Deaconess, Boston, MA, United States. 7. St Vincent's Hospital, Sydney, Australia. 8. Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN, United States.
Abstract
INTRODUCTION: To facilitate coaxial device deployment in transcatheter mitral valve replacement (TMVR), a coaxial approach to the mitral annular plane is needed. We sought to establish a method to determine an 'orthogonal' left ventricular (LV) access point for transapical TMVR and to quantitatively characterize its location in patients with severe mitral regurgitation using cardiac computed tomography. METHODS: Cardiac CT data sets of 54 patients with moderate-severe mitral regurgitation evaluated for potential TMVR were analyzed. The D-shaped mitral annular contour was segmented and a 2-dimensional annular plane was derived, allowing for subsequent definition of the perpendicularly oriented mitral annular trajectory. The 'orthogonal' LV access point was defined as the transection point of mitral trajectory with the LV epicardial surface. The location of the access point was quantified by its epicardial distance from the true apex and by the rotational offset from a 3-chamber view. RESULTS: LV access points orthogonal to the mitral annular plane were most frequently located in the anterolateral (n = 22, 40.7%) and anterior (n = 16, 29.6%), less frequently anteroseptal (n = 6, 11.1%) and inferolateral (n = 5, 9.3%) ventricular segment; none inferior or inferoseptal. The mean distance to the LV apex was 17.6 ± 7.7 mm. The mean forward rotational offset from the 3-chamber view was 96.4 ± 43.4°, relating to a mean forward rotational offset of 6.4 ± 43.4° in regard to a hypothetical, secondary 90° x-plane view. No significant difference between patients with degenerative mitral valve disease or functional mitral regurgitation was observed. CONCLUSION: The location of the LV access point that provides an orthogonal trajectory to the mitral annular plane exhibits relevant inter-individual variability. It is commonly not identical with the true apex, and frequently localized in the anterolateral or anterior ventricular segments.
INTRODUCTION: To facilitate coaxial device deployment in transcatheter mitral valve replacement (TMVR), a coaxial approach to the mitral annular plane is needed. We sought to establish a method to determine an 'orthogonal' left ventricular (LV) access point for transapical TMVR and to quantitatively characterize its location in patients with severe mitral regurgitation using cardiac computed tomography. METHODS: Cardiac CT data sets of 54 patients with moderate-severe mitral regurgitation evaluated for potential TMVR were analyzed. The D-shaped mitral annular contour was segmented and a 2-dimensional annular plane was derived, allowing for subsequent definition of the perpendicularly oriented mitral annular trajectory. The 'orthogonal' LV access point was defined as the transection point of mitral trajectory with the LV epicardial surface. The location of the access point was quantified by its epicardial distance from the true apex and by the rotational offset from a 3-chamber view. RESULTS: LV access points orthogonal to the mitral annular plane were most frequently located in the anterolateral (n = 22, 40.7%) and anterior (n = 16, 29.6%), less frequently anteroseptal (n = 6, 11.1%) and inferolateral (n = 5, 9.3%) ventricular segment; none inferior or inferoseptal. The mean distance to the LV apex was 17.6 ± 7.7 mm. The mean forward rotational offset from the 3-chamber view was 96.4 ± 43.4°, relating to a mean forward rotational offset of 6.4 ± 43.4° in regard to a hypothetical, secondary 90° x-plane view. No significant difference between patients with degenerative mitral valve disease or functional mitral regurgitation was observed. CONCLUSION: The location of the LV access point that provides an orthogonal trajectory to the mitral annular plane exhibits relevant inter-individual variability. It is commonly not identical with the true apex, and frequently localized in the anterolateral or anterior ventricular segments.
Authors: Keshav Kohli; Zhenglun Alan Wei; Ajit P Yoganathan; John N Oshinski; Jonathon Leipsic; Philipp Blanke Journal: Curr Treat Options Cardiovasc Med Date: 2018-10-26
Authors: Gianluca Pontone; Alexia Rossi; Marco Guglielmo; Marc R Dweck; Oliver Gaemperli; Koen Nieman; Francesca Pugliese; Pal Maurovich-Horvat; Alessia Gimelli; Bernard Cosyns; Stephan Achenbach Journal: Eur Heart J Cardiovasc Imaging Date: 2022-03-22 Impact factor: 9.130