title: Feasibility of cardiovascular magnetic resonance to assess the orifice area of aortic bioprostheses.
abstract: BACKGROUND
  Prosthetic orifice area, usually calculated by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), provides important information regarding the hemodynamic performance of aortic bioprostheses. However, both TTE and TEE have limitations; therefore accurate and reproducible determination of the orifice area often remains a challenge. The present study aimed to investigate the feasibility of cardiovascular magnetic resonance (CMR) to assess the orifice areas of aortic bioprostheses.
  
  
  RESULTS
  CMR planimetry of the orifice area was performed in 65 patients (43/22 stented/stentless prostheses; mean time since implantation, 3.1+/-2.8 years; mean orifice area [TTE], 1.70+/-0.43 cm(2); 62 normally functioning prostheses, 2 severe stenoses, and 1 severe regurgitation) in an imaging plane perpendicular to the transprosthetic flow using steady-state free-precession cine imaging under breath-hold conditions on a 1.5-T MR system. CMR results were compared with TTE (continuity equation, n=65) and TEE (planimetry, n=31). CMR planimetry was readily feasible in 80.0%; feasible with limitation in 15.4% because of stent, flow, and sternal wire artifacts; and impossible in 4.6% because of flow artifacts. Correlations of the orifice areas by CMR with TTE (r=0.82) and CMR with TEE (r=0.92) were significant. The average difference between the methods was -0.02+/-0.24 cm(2) (TTE) and 0.05+/-0.15 cm(2) (TEE). Agreement was present for stented and stentless devices and independent of orifice size. Intraobserver and interobserver variabilities of CMR planimetry were 6.7+/-5.4% and 11.5+/-7.8%.
  
  
  CONCLUSIONS
  The assessment of aortic bioprostheses with normal orifice areas by CMR is technically feasible and provides orifice areas with a close correlation to echocardiography and low observer dependency.
authors.affiliation: Franz-Volhard-Klinik for Cardiology, HELIOS Klinikum Berlin Buch, University Medicine Berlin, Charité Campus Buch, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: von Knobelsdorff-Brenkenhoff
authors.forename: André
authors.initials: A
authors.lastname: Rudolph
authors.forename: Ralf
authors.initials: R
authors.lastname: Wassmuth
authors.forename: Steffen
authors.initials: S
authors.lastname: Bohl
authors.forename: Eva Elina
authors.initials: EE
authors.lastname: Buschmann
authors.forename: Hassan
authors.initials: H
authors.lastname: Abdel-Aty
authors.forename: Rainer
authors.initials: R
authors.lastname: Dietz
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000473:pathology; D001705:Bioprosthesis; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D011474:Prosthesis Design; D015203:Reproducibility of Results; D015607:Stents; D013997:Time Factors