Selection patients for TAVI – optimal measurement of aortic valve annulus

    Authors

    Keywords

    transcatheter aortic valve implantation, computed tomography

    DOI

    https://doi.org/10.15836/ccar2016.485

    Full Text

    **Background**. In selection patients for transcatheter aortic valve implantation (TAVI), one of the most important measurements is aortic annulus dimension for optimal valve type selection and sizing, being crucial for the procedure success. (1) The aim of the study is to validate different echocardiography tools versus CT for aortic annulus measurement. **Methods and Results**. 24 consecutive patients who underwent successful CoreValve implantation in University Hospital Center Zagreb were enrolled. Selection of valve dimension was based on CT measurements of aortic annulus (mean diameter and perimeter). All patients underwent transthoracic echocardiography (TTE) prior procedure. 2D transesophageal (TOE) echo was performed in all but one patient (due to contraindications), and 3D TOE in 13 pts. Data was analyzed retrospectively, investigator being blinded for the implanted valve size. Annulus diameter was measured from 2D TTE parasternal view, 2D TOE (120°) and 3D multiplane views. 3D TOE perimeter derived annulus diameter was also obtained. 4 CT examinations were incongruent with the implanted valve size. Compared to CT measurements, only 9/24 (37.5%) pts were correctly measured by 2D TTE and 15 pts (62.5%) were undersized. For 2D TOE compared to CT, 11/23 (47.8%) measurements were correct, 10 (43.5%) undersized and 2 (8.7%) oversized. 3D TOE compared to CT was correct in 10/13 (76.9%) pts, 1 (7.7%) being undersized, and 2 (15.4%) oversized. The majority of patients were implanted CoreValve size 26 (13 pts) and 29 (7 pts) – multimodality measurements are shown in **Table 1**. 2D TTE and TOE underestimate annulus size compared to CT for 1-3mm. 3D TOE measurements differ from CT for <0.5mm. ### Table 1: Comparation of the multimodality measurements of aortic annulus dimensions for two most used CoreValve sizes (26 and 29) | | **CT** | **3D TOE** | **2D TOE** | **2D TTE** | | --- | --- | --- | --- | --- | | **CoreValve 26** | | | | | | **Mean annulus diameter** | 22.1 | 21.5 | 20.91 | 20.4 | | **Perimetry derived diameter** | 22.2 | 22.6 | | | | **CoreValve 29** | | | | | | **Mean annulus diameter** | **24.1** | **23.7** | **21.6** | **21.4** | | **Perimetry derived diameter** | 24.6 | 26.6 | | | **Conclusion.** CT, as well as 3D TOE have been shown to provide more accurate aortic annulus geometric measurements. Unlike 2D TTE and TOE they, especially combined, can estimate correct valve size and overstep pitfalls, even when aortic annulus is oval shaped, irregular or severely calcified.

    Literature

    1. Zamorano J, Gonçalves A, Lancellotti P, Andersen KA, González-Gómez A, Monaghan M, et al. The use of imaging in new transcatheter interventions: an EACVI review paper. Eur Heart J Cardiovasc Imaging. 2016 Aug;17(8):835–835af. https://doi.org/10.1093/ehjci/jew043
    Cardiologia Croatica
    Back to search

    Selection patients for TAVI – optimal measurement of aortic valve annulus

    Extended Abstract
    Issue10-11
    Published
    Pages485-486
    PDF via DOIhttps://doi.org/10.15836/ccar2016.485
    transcatheter aortic valve implantation
    computed tomography

    Authors

    Vlatka Rešković Lukšić*ORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Jana Ljubas MačekORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Sandra VečerićORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Sanja CekovićORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Martina Lovrić BenčićORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: vlatka.reskovic@gmail.com

    Full Text

    Background. In selection patients for transcatheter aortic valve implantation (TAVI), one of the most important measurements is aortic annulus dimension for optimal valve type selection and sizing, being crucial for the procedure success. (1) The aim of the study is to validate different echocardiography tools versus CT for aortic annulus measurement.

    Methods and Results. 24 consecutive patients who underwent successful CoreValve implantation in University Hospital Center Zagreb were enrolled. Selection of valve dimension was based on CT measurements of aortic annulus (mean diameter and perimeter). All patients underwent transthoracic echocardiography (TTE) prior procedure. 2D transesophageal (TOE) echo was performed in all but one patient (due to contraindications), and 3D TOE in 13 pts. Data was analyzed retrospectively, investigator being blinded for the implanted valve size. Annulus diameter was measured from 2D TTE parasternal view, 2D TOE (120°) and 3D multiplane views. 3D TOE perimeter derived annulus diameter was also obtained. 4 CT examinations were incongruent with the implanted valve size. Compared to CT measurements, only 9/24 (37.5%) pts were correctly measured by 2D TTE and 15 pts (62.5%) were undersized. For 2D TOE compared to CT, 11/23 (47.8%) measurements were correct, 10 (43.5%) undersized and 2 (8.7%) oversized. 3D TOE compared to CT was correct in 10/13 (76.9%) pts, 1 (7.7%) being undersized, and 2 (15.4%) oversized. The majority of patients were implanted CoreValve size 26 (13 pts) and 29 (7 pts) – multimodality measurements are shown in Table 1. 2D TTE and TOE underestimate annulus size compared to CT for 1-3mm. 3D TOE measurements differ from CT for <0.5mm.

    Table 1: Comparation of the multimodality measurements of aortic annulus dimensions for two most used CoreValve sizes (26 and 29)

    CoreValve 26
    Mean annulus diameter
    CT
    22.1
    3D TOE
    21.5
    2D TOE
    20.91
    2D TTE
    20.4
    Perimetry derived diameter
    CT
    22.2
    3D TOE
    22.6
    CoreValve 29
    Mean annulus diameter
    CT
    24.1
    3D TOE
    23.7
    2D TOE
    21.6
    2D TTE
    21.4
    Perimetry derived diameter
    CT
    24.6
    3D TOE
    26.6

    Conclusion. CT, as well as 3D TOE have been shown to provide more accurate aortic annulus geometric measurements. Unlike 2D TTE and TOE they, especially combined, can estimate correct valve size and overstep pitfalls, even when aortic annulus is oval shaped, irregular or severely calcified.

    Literature

    1. 1.
      Zamorano J, Gonçalves A, Lancellotti P, Andersen KA, González-Gómez A, Monaghan M, et al. The use of imaging in new transcatheter interventions: an EACVI review paper. Eur Heart J Cardiovasc Imaging. 2016 Aug;17(8):835–835af.DOI