Michela Tezza1, Maarten Witsenburg2, Koen Nieman3, Pieter C van de Woestijne4, Ricardo P J Budde3. 1. Department of Radiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands; Department of Radiology, Fracastoro Hospital ULSS 9, v. Circonvallazione 1, San Bonifacio, 37047, Verona, Italy. Electronic address: tezza.michela@gmail.com. 2. Department of Cardiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands. 3. Department of Radiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands. 4. Department of Cardiothoracic Surgery, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands.
Abstract
BACKGROUND: Coronary compression (CC) is a life threatening complication that can occur during percutaneous pulmonary valve implantation (PPVI). We describe our experience using cardiac CT prior to PPVI to identify patients at high CC-risk due to a close relationship between the coronary arteries and pulmonary trunk (PT). METHODS: A retrospective evaluation of candidates for PPVI who underwent CT prior to the procedure was done. Measurements of PT were performed using double oblique reconstructed images, with special attention to the stenotic tract of the PT. The analysis of coronary arteries included detection of anomalies of origin and course and assessment of their relationship with the PT, measuring the minimum distance between the coronary artery and the intended site of the future percutaneous valve implantation. RESULTS: CT analysis was performed for 52 patients. Thirty patients underwent PPVI after CT and 22 didn't. In 6/22 cases the reason not to receive a PPVI was high CC-risk detected at CT. In 6 other patients CT detected an intermediate CC-risk but the test balloon performed during angiography prior to valve placement was safe and the patients successfully underwent the procedure. None of the patients deemed as no CC-risk at CT had CC during PPVI. CONCLUSION: CT can detect patients with high and intermediate CC-risk and therefore may identify which patients are unlikely to undergo successful PPVI and those who need a careful analysis with balloon testing. CT can also rule out CC-risk identifying those patients in which balloon inflation testing could be omitted.
BACKGROUND: Coronary compression (CC) is a life threatening complication that can occur during percutaneous pulmonary valve implantation (PPVI). We describe our experience using cardiac CT prior to PPVI to identify patients at high CC-risk due to a close relationship between the coronary arteries and pulmonary trunk (PT). METHODS: A retrospective evaluation of candidates for PPVI who underwent CT prior to the procedure was done. Measurements of PT were performed using double oblique reconstructed images, with special attention to the stenotic tract of the PT. The analysis of coronary arteries included detection of anomalies of origin and course and assessment of their relationship with the PT, measuring the minimum distance between the coronary artery and the intended site of the future percutaneous valve implantation. RESULTS: CT analysis was performed for 52 patients. Thirty patients underwent PPVI after CT and 22 didn't. In 6/22 cases the reason not to receive a PPVI was high CC-risk detected at CT. In 6 other patients CT detected an intermediate CC-risk but the test balloon performed during angiography prior to valve placement was safe and the patients successfully underwent the procedure. None of the patients deemed as no CC-risk at CT had CC during PPVI. CONCLUSION: CT can detect patients with high and intermediate CC-risk and therefore may identify which patients are unlikely to undergo successful PPVI and those who need a careful analysis with balloon testing. CT can also rule out CC-risk identifying those patients in which balloon inflation testing could be omitted.
Authors: Barry O'Callaghan; Jenny Zablah; Ryan Leahy; Michael Shorofsky; Joseph Kay; Gareth Morgan Journal: Postepy Kardiol Interwencyjnej Date: 2021-07-09 Impact factor: 1.426