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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Aortic annulus sizing in stenotic bicommissural non-raphe-type bicuspid aortic valves: reconstructing a
Antonio H Frangieh1, Jonathan Michel1, Oliver Deutsch2
1Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
Summary
Accurate sizing for bicuspid aortic valve (BAV) patients undergoing transcatheter aortic valve implantation (TAVI) is crucial. A novel manual multi-planar reconstruction (MPR) technique for bicommissural non-raphe-type BAV shows promising results for precise annular assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Bicuspid aortic valve (BAV) presents unique challenges for transcatheter aortic valve implantation (TAVI).
- Bicommissural non-raphe-type BAV (Sievers and Schmidtke Type 0) is a less common variant requiring specific anatomical assessment.
- Accurate aortic root and annular sizing is critical for successful TAVI outcomes in BAV patients.
Purpose of the Study:
- To propose and evaluate a novel manual multi-planar reconstruction (MPR) technique for precise aortic annular sizing in bicommissural non-raphe-type BAV.
- To address the limitations of current software in reconstructing 3D anatomy from two hinge points in this specific BAV morphology.
Main Methods:
- Retrospective and prospective analysis of 12 patients with bicommissural non-raphe-type BAV undergoing TAVI.
- Manual assessment of the aortic root using MPR software, aligning the two hinge points to measure the smallest annular dimensions in the transverse plane.
- Comparison of the novel annulus measurement with implanted transcatheter heart valve (THV) size.
Main Results:
- The novel sizing strategy was prospectively applied in three patients with good outcomes.
- Concordance between the novel annulus measure and implanted THV size was observed in 7 out of 9 retrospectively assessed cases.
- No overestimation of annulus dimensions occurred, and in two cases, the measure might have suggested a smaller THV size.
Conclusions:
- Manual MPR assessment by aligning hinge points offers a viable strategy for accurate aortic annular sizing in bicommissural non-raphe-type BAV for TAVI.
- This technique shows potential to guide THV selection and avoid oversizing.
- Further prospective validation of this multi-detector computed tomography (MDCT) sizing technique is warranted.
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