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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Value of cardiac CT in comprehensive aortic valve and root evaluation before percutaneous aortic valve replacement
Mohamed Fayez Bazeed1, Ahmad Ibrahim Rezk2, Mohamed Saleh Moselhy3
1Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University m_bazeed@yahoo.com.
Insights
Cardiac CT accurately assesses aortic valve calcification and annulus diameter before aortic valve replacement. This imaging technique aids in evaluating coronary artery anatomy, improving surgical planning for patients with severe aortic stenosis.
Area of Science:
- Cardiovascular Imaging
- Cardiac Surgery
- Radiology
Background:
- Aortic stenosis (AS) is a prevalent valvular heart disease with a high risk of sudden death.
- Aortic valve replacement is the sole effective treatment for advanced AS.
- Preoperative evaluation is crucial for selecting the appropriate valve and implantation technique.
Purpose of the Study:
- To determine the utility of cardiac computed tomography (CT) in evaluating the aortic valve and aortic root.
- To assess the role of cardiac CT in planning percutaneous aortic valve replacement (PAVR).
Main Methods:
- Cardiac CT was performed on 34 patients with severe AS.
- Aortic valve calcification, aortic annulus diameter (CAAD), and distances from the annulus to coronary ostia were measured.
- CT findings were compared with intraoperative measurements and transthoracic echocardiography (TTE) data.
Main Results:
- Strong agreement was observed between cardiac CT and intraoperative grading of aortic valve calcification (k = 0.865).
- Cardiac CT showed a higher correlation for CAAD (r = 0.948) compared to TTE (r = 0.660).
- Cardiac CT accurately measured distances to coronary ostia (r = 0.966 right, r = 0.940 left) and identified coronary artery lesions.
Conclusions:
- Cardiac CT significantly enhances the preoperative assessment of aortic root morphology for aortic valve replacement.
- The findings support the use of cardiac CT for comprehensive pre-procedural evaluation in patients undergoing aortic valve replacement.
Background:
Aortic stenosis (AS) is the most frequent valvular heart disease, and patients who develop AS are at a high risk of sudden death. There is no medical cure available, and aortic valve replacement is the only effective treatment for advanced disease. Preoperative evaluation is the cornerstone of therapy and is necessary for selecting the implantation technique and valve.
Purpose:
To evaluate the role of cardiac CT in comprehensive aortic valve and aortic root evaluation before percutaneous aortic valve replacement.
Material And Methods:
Thirty-four patients with severe aortic valve stenosis were evaluated by cardiac CT. The aortic valve calcification grade defined by cardiac CT was compared to the operative findings. The mean calculated aortic annulus diameter (CAAD) measured by cardiac CT was compared to the aortic annulus diameter measured by transthoracic echocardiography (TTE) as well as during the operation. The distances from the aortic valve annulus to the coronary ostia (right and left) were measured by cardiac CT and compared to the intraoperative measurements. The findings from the CT coronary angiography and conventional coronary angiography were compared.
Results:
There was strong agreement (k = 0.865) between the calcification grade by cardiac CT and the intraoperative grading. There was a stronger correlation (r = 0.948) between the CAAD assessed by cardiac CT and intraoperatively compared to the correlation between the intraoperative versus TTE measurements (r = 0.660). The distances measured between the aortic annulus and the right and left coronary artery ostia by cardiac CT were strongly correlated with the distances measured intraoperatively (r = 0.966 and 0.940 in the right and left sides, respectively). Cardiac CT detected three coronary artery stenotic lesions and three patent stents. All findings were confirmed by conventional coronary angiography. Thirteen percent of the evaluated coronary artery segments were of non-diagnostic quality by cardiac CT.
Conclusion:
Cardiac CT substantially facilitates the assessment of aortic root morphology prior to aortic valve replacement.
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