Evaluation of aortic root and valve calcifications by multi-detector computed tomography

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Percutaneous aortic valve replacement (AVR) relies on calcifications as landmarks but faces challenges due to severe aortic root calcification.
• Understanding the precise nature of aortic root calcification is crucial for optimizing percutaneous valve deployment.

Purpose of the Study:

• To investigate severe aortic root and valve calcification using multi-detector computed tomography (MDCT).
• To characterize calcification patterns and their relationship with coronary ostia for improved percutaneous AVR planning.

Main Methods:

• ECG-gated 64-slice MDCT was used to measure aortic annulus dimensions and calcification severity in 33 patients with severe aortic stenosis.
• Distances of calcifications and coronary ostia from the annulus were quantified, and calcification extent was categorized.

Main Results:

• Annulus calcification was present in all patients, with 50% classified as severe.
• Valvular calcification extended to the coronary ostia level in 36% of patients, with 42% exhibiting low coronary ostia.
• Calcification extended into the interventricular septum and mitral valve leaflet in 36% and 42% of cases, respectively.

Conclusions:

• Cardiac MDCT is a valuable pre-procedural tool for patient selection in percutaneous AVR, offering superior visualization of calcified valves compared to echocardiography.
• Accurate characterization of aortic root and valve calcification by MDCT aids precise stent placement and helps prevent coronary artery occlusion.
• MDCT findings are critical for planning future valve designs and improving percutaneous AVR outcomes.