Cardiovascular magnetic resonance as a reliable alternative to cardiovascular computed tomography and transesophageal echocardiography for aortic annulus valve sizing.
To assess the accuracy and reproducibly of cardiovascular magnetic resonance (CMR) in the measurement of the aortic annulus and in process of valve sizing as compared to intra-operative sizing, cardiovascular computed tomography (CCT) and transesophageal echocardiography (TEE). Retrospective study on 42 patients who underwent aortic valve replacement from September 2010 to September 2015, with available records of pre surgery annulus assessment by CMR, CCT and TEE and of peri-operative assessment. In CCT and CMR, the annular plane was considered a virtual ring formed by the lowest hinge points of the valvular attachments to the aorta. In TEE the annulus was measured at the base of leaflet insertion in the mid-esophageal long-axis view using the X-plane technique. Two double-blinded operators performed the assessments for each imaging technique. Intra-operative evaluation was performed using Hegar dilators. Continuous variables were studied with within-subject ANOVA, Bland-Altman (BA) plots, Wilcoxon's and Friedman's tests; trends were explored with scatter plots. Categorical variables were studied with Fisher's exact test. The intra- and inter-operator reliability was satisfying. There were no significant differences between the annulus dimensions measured by CMR and either one of the three references. Valve sizing for CoreValve by CMR had the same good agreement with CCT and TEE, with a 78 % match rate; for SAPIEN XT the agreement was slightly better (82 %) for CCT than for TEE (66 %). MR performs well when compared to the surgical reference of intra-operative sizing and stands up to the level of the most used imaging references (CCT and TEE).
Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy. riccardo.faletti@unito.it.
Riccardo
R
Faletti
Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
Marco
M
Gatti
Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
Stefano
S
Salizzoni
Department of Surgical Sciences, University of Turin, Turin, Italy.
Laura
L
Bergamasco
Department of Surgical Sciences, University of Turin, Turin, Italy.
Rodolfo
R
Bonamini
Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Turin, Italy.
Domenica
D
Garabello
Division of Cardiology, Department of Medical Sciences,, University of Turin, Turin, Italy.
Walter Grosso
WG
Marra
Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
Michele
M
La Torre
Division of Cardiology, Department of Medical Sciences,, University of Turin, Turin, Italy.
Mara
M
Morello
Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Turin, Italy.
Simona
S
Veglia
Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
Paolo
P
Fonio
Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
Mauro
M
Rinaldi
D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
Aortic stenosis; Cardiovascular computed tomography; Cardiovascular magnetic resonance; Transcatheter aortic valve implantation; Transesophageal echocardiography