title: Inter-individual variance and cardiac cycle dependency of aortic root dimensions and shape as assessed by ECG-gated multi-slice computed tomography in patients with severe aortic stenosis prior to transcatheter aortic valve implantation: is it crucial for correct sizing?
abstract: To evaluate the inter-individual variance and the variability of the aortic root dimensions during the cardiac cycle by computed tomography (CT) in patients with severe aortic stenosis prior to transcatheter aortic valve implantation (TAVI). Fifty-six patients (m/w = 16/40, 81 ± 6.8 years), scheduled for a transapical aortic valve implantation with available preprocedural ECG-gated CT were retrospectively included. The evaluation included sizing of the aortic annulus and the aortic sinus, measurements of the coronary topography, aortic valve planimetry and scoring of calcification. The new defined aortic annulus sphericity ratio revealed a mostly elliptical shape with increasing diastolic deformation. The calculated effective diameter (ED), determined from the annulus' lumen area, turned out to be the parameter least affected from cardiac cycle changes while systolic and diastolic annulus dimensions and shape (diameter and area) differed significantly (p < 0.001). In about 70 % of the patients with relevant paravalvular leaks the finally implanted prosthesis was too small according to the CT based calculated ED. The ostial height of the coronaries showed a high variability with a critical minimum range <5 mm. The degree of the aortic calcification did not have an influence on the aortic annulus deformation during the cardiac cycle, but on the occurrence of paravalvular leaks. The aortic root anatomy demonstrated a high inter-individual variability and cardiac cycle dependency. These results must be strongly considered during the patient evaluation prior to TAVI to avoid complications. The systolic effective diameter, as measured by ECG-gated CT, represents an appropriate parameter for sizing the aortic annulus.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Centre, Strümpellstrasse 39, 04289 Leipzig, Germany. lukas.lehmkuhl@med.uni-leipzig.de
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehmkuhl
authors.forename: Borek
authors.initials: B
authors.lastname: Foldyna
authors.forename: Konstantin
authors.initials: K
authors.lastname: Von Aspern
authors.forename: Christian
authors.initials: C
authors.lastname: Lücke
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Stefan
authors.initials: S
authors.lastname: Nitzsche
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Martin
authors.initials: M
authors.lastname: Haensig
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D055424:Cardiac-Gated Imaging Techniques; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome