کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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2940819 | 1177045 | 2012 | 11 صفحه PDF | دانلود رایگان |

ObjectivesThis study sought to investigate pulsatile changes of the aortic annulus and their impact on prosthesis selection by computed tomography (CT).BackgroundPrecise noninvasive prosthesis sizing is a prerequisite for transcatheter aortic valve replacement.MethodsA total of 110 patients with severe aortic stenosis (mean age: 82.9 ± 8 years, mean aortic valve area: 0.69 ± 0.18 cm2) underwent electrocardiogram-gated CT. Aortic annulus dimensions were planimetrically quantified as area-derived diameter (DA = 2 ×✓(CSA/π), where CSA is the cross-sectional area) and perimeter-derived diameter (DP = P/π, where P is the length of the perimeter) in 5% increments of the RR interval. Hypothetical prosthesis sizing was based on DA and DP (23-mm prosthesis for <22 mm; 26 mm: 22 to 25 mm; 29 mm: >25 mm) and compared between maximum and traditional cardiac CT reconstruction phases at 35% and 75% of RR. Agreement for prosthesis selection was calculated by κ statistics.ResultsDA and DP were increased and eccentricity was reduced during systole, with DA-MAX and DP-MAX most often observed at 20% of RR. DP was consistently larger than DA. Average net differences were 2.0 ± 0.6 mm and 1.7 ± 0.5 mm by DA-MIN versus DA-MAX and DP-MIN versus DP-MAX. Agreement for prosthesis sizing was found in 93 of 110 patients (κ = 0.75) by DA-75% and in 80 of 110 patients (κ = 0.53) by DA-MAX compared with DA-35%; and in 94 of 110 patients (κ = 0.73) by DP-75% and in 93 of 110 patients (κ = 0.73) by DP-MAX compared with DP-35%. With sizing by DA-75% or DP-75%, nominal prosthesis diameter was smaller than DA-MAX or DP-MAX in 15 and 6 patients respectively.ConclusionsAortic annulus morphology exhibits conformational pulsatile changes throughout the cardiac cycle due to deformation and stretch. These changes affect prosthesis selection. Prosthesis selection by diastolic perimeter- or area-derived dimensions harbors the risk of undersizing.
Journal: JACC: Cardiovascular Interventions - Volume 5, Issue 9, September 2012, Pages 984–994